Healthcare Provider Details

I. General information

NPI: 1710796727
Provider Name (Legal Business Name): YANAISY BENITEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 E FOUR SEASONS RD
WEST PALM BEACH FL
33410-6305
US

IV. Provider business mailing address

82 E FOUR SEASONS RD
WEST PALM BEACH FL
33410-6305
US

V. Phone/Fax

Practice location:
  • Phone: 561-674-5162
  • Fax:
Mailing address:
  • Phone: 561-674-5162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-397595
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: