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General NPI Number Information
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NPI Number | 1114132057
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Entity Type | Individual
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Provider Name | CANISHA MONAI BENTON P.A
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Gender | Female
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 06/09/2023
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Provider Practice Location Address
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Address Line | 1210 W FARIS RD
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City | GREENVILLE
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State | SC
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Zip | 29605-4444
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Country | US
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Telephone | 864-522-1800
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Fax | 864-522-1806
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE FL 4
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City | GREENVILLE
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State | SC
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Zip | 29601-2842
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Country | US
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Telephone | 864-522-8603
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 011827
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3764
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License Number State | SC
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