Provider Demographics
NPI:1922073584
Name:BENANDI, TINA MARIE
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:BENANDI
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 1:1412 GAUDET DR
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-4022
Mailing Address - Country:US
Mailing Address - Phone:985-768-1995
Mailing Address - Fax:504-533-0114
Practice Address - Street 1:1412 GAUDET DR
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4022
Practice Address - Country:US
Practice Address - Phone:985-768-1995
Practice Address - Fax:504-533-0114
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center