Healthcare Provider Details

I. General information

NPI: 1356957302
Provider Name (Legal Business Name): ANNA BENALI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 10/07/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10550 DEERWOOD PARK BLVD STE 110
JACKSONVILLE FL
32256-0591
US

IV. Provider business mailing address

4620 N SR7
LAUDERDALE LAKES FL
33319
US

V. Phone/Fax

Practice location:
  • Phone: 904-977-3877
  • Fax:
Mailing address:
  • Phone: 561-609-0770
  • Fax: 561-997-1246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-78106
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: