Individual
AMY ROSE BENENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPAS, PA-C
Contact information
Practice address
289 WINDHAM RD, WILLIMANTIC, CT 06226-3528
(860) 343-0302
Mailing address
302 FIELDSTONE, LEDYARD, CT 06339-1250
(516) 304-8956
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
PA01468
RI
363AM0700X
Medical Physician Assistant
Primary
5717
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA01468
—
RI
Enumeration date
06/15/2022
Last updated
01/04/2024
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