NPI 1427788009 · live from the CMS NPI Registry
Amy Rose Benenson, MSPAS, PA-C
Physician Assistant, Medical in Willimantic, CT. National Provider Identifier 1427788009, active.
NPI record
| NPI | 1427788009 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant, Medical 363AM0700X |
| Practice location | 289 Windham Rd, Willimantic, CT 06226 |
| Practice phone | 860-343-0302 |
| Mailing address | 302 Fieldstone, Ledyard, CT 06339 |
| Enumerated | June 15, 2022 |
| Last updated | January 4, 2024 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Medicine, Addiction Medicine | 207QA0401X | PA01468 (RI) |
| Physician Assistant, Medical primary | 363AM0700X | 5717 (CT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.