Provider Demographics
NPI:1043472095
Name:BENEBY, DEBORAH ANN
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:BENEBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:561-478-8770
Mailing Address - Fax:
Practice Address - Street 1:1900 TAMIAMI TRL
Practice Address - Street 2:SUITE 109
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-2180
Practice Address - Country:US
Practice Address - Phone:941-743-5211
Practice Address - Fax:941-743-6380
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1550231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001298800Medicaid
FLC1878YMedicare PIN
FL001298800Medicaid