Provider Demographics
NPI:1356798961
Name:BENCOMO, DANAY (NO)
Entity type:Individual
Prefix:
First Name:DANAY
Middle Name:
Last Name:BENCOMO
Suffix:
Gender:F
Credentials:NO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W 50TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3413
Mailing Address - Country:US
Mailing Address - Phone:786-717-8011
Mailing Address - Fax:
Practice Address - Street 1:801 W 50TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3413
Practice Address - Country:US
Practice Address - Phone:786-717-8011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1457659310Medicaid