Healthcare Provider Details

I. General information

NPI: 1366972804
Provider Name (Legal Business Name): LISA DONNIS BENBASAT RD, LD/N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S CONGRESS AVE
DELRAY BEACH FL
33445
US

IV. Provider business mailing address

800 CLEMATIS ST STE 5-531
WEST PALM BEACH FL
33401-5107
US

V. Phone/Fax

Practice location:
  • Phone: 561-274-1350
  • Fax: 561-274-3103
Mailing address:
  • Phone: 561-671-4043
  • Fax: 561-837-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberND1951
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: