Provider Demographics
NPI:1073196150
Name:BENTLEY, DAFNA YAEL (BS)
Entity Type:Individual
Prefix:
First Name:DAFNA
Middle Name:YAEL
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6712 SOUTH HIGHWAY 837
Mailing Address - Street 2:
Mailing Address - City:BETHELRIDGE
Mailing Address - State:KY
Mailing Address - Zip Code:42516
Mailing Address - Country:US
Mailing Address - Phone:727-420-8728
Mailing Address - Fax:
Practice Address - Street 1:6712 SOUTH HIGHWAY 837
Practice Address - Street 2:
Practice Address - City:BETHELRIDGE
Practice Address - State:KY
Practice Address - Zip Code:42516
Practice Address - Country:US
Practice Address - Phone:727-420-8728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty