Provider Demographics
NPI:1417650417
Name:BENITEZ, ALYSSA SAMANTHA (BACHELORS)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:SAMANTHA
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:BACHELORS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6660 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6533
Mailing Address - Country:US
Mailing Address - Phone:786-709-3131
Mailing Address - Fax:
Practice Address - Street 1:17900 NW 5TH ST STE 203
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2808
Practice Address - Country:US
Practice Address - Phone:954-606-5439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI57742355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant