Healthcare Provider Details

I. General information

NPI: 1043174097
Provider Name (Legal Business Name): ANTONELLA BEHNCKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16300 GOLF CLUB RD APT 213
WESTON FL
33326-1660
US

IV. Provider business mailing address

16300 GOLF CLUB RD APT 213
WESTON FL
33326-1660
US

V. Phone/Fax

Practice location:
  • Phone: 954-319-0546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND6482
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: