Healthcare Provider Details

I. General information

NPI: 1134110307
Provider Name (Legal Business Name): MAYA N BENTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAYA BOROFSKY

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4807 US HIGHWAY 19 STE 102
NEW PORT RICHEY FL
34652-4260
US

IV. Provider business mailing address

4807 US HIGHWAY 19 STE 102
NEW PORT RICHEY FL
34652-4260
US

V. Phone/Fax

Practice location:
  • Phone: 727-939-2230
  • Fax: 727-847-5349
Mailing address:
  • Phone: 727-939-2230
  • Fax: 727-847-5349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9102942
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: