Healthcare Provider Details

I. General information

NPI: 1659235927
Provider Name (Legal Business Name): TIFFANY L BENEDICT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CENTERVIEW DR STE 100
GREENSBORO NC
27407-3712
US

IV. Provider business mailing address

1404 HYALYN CT
GREENSBORO NC
27406-9557
US

V. Phone/Fax

Practice location:
  • Phone: 336-858-3474
  • Fax:
Mailing address:
  • Phone: 336-858-3474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: