Healthcare Provider Details

I. General information

NPI: 1770373896
Provider Name (Legal Business Name): SYDNEY BENAVIDEZ MPAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 S 600 E APT 21
PROVO UT
84606-3281
US

IV. Provider business mailing address

99 S 600 E APT 21
PROVO UT
84606-3281
US

V. Phone/Fax

Practice location:
  • Phone: 702-682-2406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA3448
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: