Provider Demographics
NPI:1134110307
Name:BENTON, MAYA N (PA-C)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:N
Last Name:BENTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MAYA
Other - Middle Name:
Other - Last Name:BOROFSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4807 US HIGHWAY 19 STE 102
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4260
Mailing Address - Country:US
Mailing Address - Phone:727-939-2230
Mailing Address - Fax:727-847-5349
Practice Address - Street 1:4807 US HIGHWAY 19 STE 102
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4260
Practice Address - Country:US
Practice Address - Phone:727-939-2230
Practice Address - Fax:727-847-5349
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102942363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3585VOtherMEDICARE PTAN
Q26627Medicare UPIN