Healthcare Provider Details

I. General information

NPI: 1467371641
Provider Name (Legal Business Name): SHANDON LUCIANNA BENJAMIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1837 N PEARL ST
JACKSONVILLE FL
32206-3663
US

IV. Provider business mailing address

1837 N PEARL ST
JACKSONVILLE FL
32206-3663
US

V. Phone/Fax

Practice location:
  • Phone: 904-339-3505
  • Fax:
Mailing address:
  • Phone: 904-339-3505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License NumberSEA2615756
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: