Healthcare Provider Details

I. General information

NPI: 1427825587
Provider Name (Legal Business Name): SHANAE NICOLE BENITO APC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 PEACHTREE ST NE STE 110
ATLANTA GA
30309-3005
US

IV. Provider business mailing address

1401 PEACHTREE ST NE STE 110
ATLANTA GA
30309-3005
US

V. Phone/Fax

Practice location:
  • Phone: 470-749-3520
  • Fax: 470-378-1997
Mailing address:
  • Phone: 470-749-3520
  • Fax: 470-378-1997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC009680
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: