Provider Demographics
NPI:1588626782
Name:BENYAHIA, SALLY ANNE (NP)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ANNE
Last Name:BENYAHIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 GAUSE BLVD W STE A
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-4130
Mailing Address - Country:US
Mailing Address - Phone:985-643-4512
Mailing Address - Fax:985-643-4513
Practice Address - Street 1:3715 WILLIAMS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3066
Practice Address - Country:US
Practice Address - Phone:504-465-4550
Practice Address - Fax:504-465-8590
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN083107208100000X
FLARNP9413902363LF0000X
LAAP04587363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H383CJ31Medicare ID - Type Unspecified
LAQ39642Medicare UPIN