Provider Demographics
NPI:1376933507
Name:BENSHOSHAN, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BENSHOSHAN
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 1:6251 PALM TRACE LANDINGS DR
Mailing Address - Street 2:APT # 113
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1841
Mailing Address - Country:US
Mailing Address - Phone:954-817-2219
Mailing Address - Fax:
Practice Address - Street 1:6251 PALM TRACE LANDINGS DR
Practice Address - Street 2:APT # 113
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-1841
Practice Address - Country:US
Practice Address - Phone:954-817-2219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA231432081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine