Provider Demographics
NPI:1306970884
Name:SEDAKA, DOCTOR BENEVOLO (LMT, CPC)
Entity type:Individual
Prefix:
First Name:DOCTOR
Middle Name:BENEVOLO
Last Name:SEDAKA
Suffix:
Gender:M
Credentials:LMT, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4124 WOLFF ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2228
Mailing Address - Country:US
Mailing Address - Phone:802-468-7253
Mailing Address - Fax:805-709-1282
Practice Address - Street 1:4124 WOLFF ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-2228
Practice Address - Country:US
Practice Address - Phone:802-468-7253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2025-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0022455225700000X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171400000XOther Service ProvidersHealth & Wellness Coach