Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | P19199 | NC |
NPI | 1023657947 |
---|---|
Provider Name | Cassidi Michelle Benavidez |
First Address | Fayetteville, NC 28314-1320 |
Second Address | Danville, VA 24540-2863 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2019 |
Last Update Date | 23/12/2019 |