Individual
BRENDAN LY BENITEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
110 KILDAIRE PARK DR, CARY, NC 27518-8162
(919) 235-6466
Mailing address
PO BOX 603949, CHARLOTTE, NC 28260-3949
(919) 350-0351
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-13994
NC
363AM0700X
Medical Physician Assistant
Primary
0010-13994
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508644873
—
NC
Enumeration date
09/18/2023
Last updated
10/08/2024
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