Healthcare Provider Details

I. General information

NPI: 1609575356
Provider Name (Legal Business Name): JUAN M BENCOMO SANCHEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 VALLEY PL
BRANDON FL
33510-2550
US

IV. Provider business mailing address

1406 VALLEY PL
BRANDON FL
33510-2550
US

V. Phone/Fax

Practice location:
  • Phone: 786-370-8953
  • Fax:
Mailing address:
  • Phone: 786-370-8953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI7260
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-259028
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ13218
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: