Healthcare Provider Details

I. General information

NPI: 1821574740
Provider Name (Legal Business Name): ALANA BENITO RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 16TH AVE S
ST PETERSBURG FL
33701-5407
US

IV. Provider business mailing address

699 16TH AVE S
ST PETERSBURG FL
33701-5407
US

V. Phone/Fax

Practice location:
  • Phone: 860-944-0232
  • Fax:
Mailing address:
  • Phone: 860-944-0232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number7058
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number7058
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: