Healthcare Provider Details

I. General information

NPI: 1588626782
Provider Name (Legal Business Name): SALLY ANNE BENYAHIA N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 WILLIAMS BLVD STE 100
KENNER LA
70065-3066
US

IV. Provider business mailing address

2104 GAUSE BLVD W STE A
SLIDELL LA
70460-4130
US

V. Phone/Fax

Practice location:
  • Phone: 504-465-4550
  • Fax: 504-465-8590
Mailing address:
  • Phone: 985-643-4512
  • Fax: 985-643-4513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP04587
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9413902
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberRN083107
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: