Healthcare Provider Details

I. General information

NPI: 1770725343
Provider Name (Legal Business Name): JOHANE BENYEHUDA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2009
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N ORANGE AVE STE 800
ORLANDO FL
32801-2381
US

IV. Provider business mailing address

111 N ORANGE AVE STE 800
ORLANDO FL
32801-2381
US

V. Phone/Fax

Practice location:
  • Phone: 407-752-9728
  • Fax: 727-292-1156
Mailing address:
  • Phone: 407-752-9728
  • Fax: 727-292-1156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number082061
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC10013010
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.135131
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number58484
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0071935
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number202303017
License Number StateNC
# 7
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME105517
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD436387
License Number StatePA
# 9
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number307372
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: