Provider Demographics
NPI:1467015644
Name:BENEVIDES, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BENEVIDES
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 1:335 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-2603
Mailing Address - Country:US
Mailing Address - Phone:772-584-7096
Mailing Address - Fax:
Practice Address - Street 1:5080 TOPAZ LN SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-5863
Practice Address - Country:US
Practice Address - Phone:305-393-0179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty