Provider Demographics
NPI:1508863572
Name:BENEZETTE, ALYN LAMAR (DO)
Entity type:Individual
Prefix:DR
First Name:ALYN
Middle Name:LAMAR
Last Name:BENEZETTE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:725 W GRANADA BLVD
Mailing Address - Street 2:SUITE 22
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-9406
Mailing Address - Country:US
Mailing Address - Phone:386-788-2300
Mailing Address - Fax:386-944-6622
Practice Address - Street 1:725 W GRANADA BLVD
Practice Address - Street 2:SUITE 22
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-9406
Practice Address - Country:US
Practice Address - Phone:386-788-2300
Practice Address - Fax:386-944-6622
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS57742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE60482Medicare UPIN
FL45556Medicare PIN
FL80352YMedicare PIN