Healthcare Provider Details

I. General information

NPI: 1427293505
Provider Name (Legal Business Name): SHERLYN ANN BENOIS-GREEN AU.D, CCC-A, FAAA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 10/24/2021
Certification Date: 10/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W PROVIDENCE AVE
ORANGE CA
92868-3808
US

IV. Provider business mailing address

1301 W PROVIDENCE AVE
ORANGE CA
92868-3808
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-4990
  • Fax: 714-221-0977
Mailing address:
  • Phone: 714-639-4990
  • Fax: 714-221-0977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHA7364
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU2563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: