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General NPI Number Information
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NPI Number | 1942018742
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Entity Type | Individual
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Provider Name | S0NIA R BENNETT MD
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Gender | Female
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Dates
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Enumeration Date | 12/25/2024
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Last Update Date | 12/25/2024
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Provider Practice Location Address
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Address Line | 1801 SE HILLMOOR DR STE A-102
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7545
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Country | US
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Telephone | 772-249-2494
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Fax |
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Provider Business Mailing Address
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Address Line | 308 W 11TH ST APT 1
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City | RIVIERA BEACH
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State | FL
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Zip | 33404-7536
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Country | US
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Telephone | 561-468-0900
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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