Provider Demographics
NPI:1780228924
Name:BENOIT, JEFFREY J (AGNP)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:BENOIT
Suffix:
Gender:M
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 UPPER RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01342-9739
Mailing Address - Country:US
Mailing Address - Phone:413-588-8268
Mailing Address - Fax:
Practice Address - Street 1:103 UPPER RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:MA
Practice Address - Zip Code:01342-9739
Practice Address - Country:US
Practice Address - Phone:413-588-8268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA170999363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology