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General NPI Number Information
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NPI Number | 1669101267
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Entity Type | Individual
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Provider Name | SHONTAE S BENISON
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Gender | Female
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 9697 BROOKPARK RD
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City | PARMA
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State | OH
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Zip | 44129-6811
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Country | US
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Telephone | 440-625-6300
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Fax | 440-625-6301
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Provider Business Mailing Address
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Address Line | 13212 TERMINAL AVE
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City | CLEVELAND
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State | OH
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Zip | 44135-4814
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Country | US
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Telephone | 440-625-6300
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Fax | 440-625-6301
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 3826HHN
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 246YR1600X
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Taxonomy Name | Registered Record Administrator
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License Number |
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State | OH
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