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General NPI Number Information
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NPI Number | 1174191993
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Entity Type | Individual
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Provider Name | MS. SHAQUAWNNA LATOYA BENJAMIN
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Gender | Female
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 06/17/2021
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Provider Practice Location Address
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Address Line | 4702 S WASHINGTON AVE
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City | TITUSVILLE
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State | FL
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Zip | 32780-7305
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Country | US
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Telephone | 407-675-1547
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Fax |
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Provider Business Mailing Address
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Address Line | 4702 S WASHINGTON AVE
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City | TITUSVILLE
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State | FL
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Zip | 32780-7305
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Country | US
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Telephone | 407-675-1547
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | FL
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