=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699170183
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARISSA BEHNING PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2014
-----------------------------------------------------
Last Update Date | 04/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2206 JO AN DR STE 1
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34231-4080
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-487-0266
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 221 ORCHARD LN
-----------------------------------------------------
City | SEWICKLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15143-1150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-612-3610
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | MA057103
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA9116858
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------