Healthcare Provider Details

I. General information

NPI: 1528325701
Provider Name (Legal Business Name): MICHELLE BENITEZ M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 05/07/2021
Certification Date: 04/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18680 SW 376TH ST
HOMESTEAD FL
33034-6304
US

IV. Provider business mailing address

9121 NW 154TH TER
MIAMI LAKES FL
33018-1410
US

V. Phone/Fax

Practice location:
  • Phone: 561-339-0637
  • Fax:
Mailing address:
  • Phone: 561-339-0637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberME126369
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME126369
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: