MEDICARE: SARAH BENENSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	1190477	FL

General Provider Information

NPI Number	:	1336835115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH BENENSON

Provider Business Mailing Address
First Line	:	PO BOX 361095
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32936-1095
Country	:	US
Telephone Number	:	321-253-2900
Fax Number	:	321-435-0100

Provider Business Practice Location Address
First Line	:	1555 W NASA BLVD UNIT B1
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-2640
Country	:	US
Telephone Number	:	321-341-1700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2023
Last Update Date	:	04/14/2023

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Directions to “ SARAH BENENSON ” Practice Location

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