# AMITHA BENA OMONUWA

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1821310426
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA9109689 | FL | Yes |

## Other

- **Enumeration date:** 02/23/2010
- **Last updated:** 03/29/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01348305 | AMERIGROUP | GA |
| 05 | — | 019421700 | — | FL |
| 05 | — | 354613564A | — | GA |
| 05 | — | 354613564B | — | GA |
| 01 | — | 551847 | WELLCARE | GA |