Provider Demographics
NPI:1154353506
Name:BENSHOOF, BONNIE G (PHD)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:G
Last Name:BENSHOOF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 N PARTIN DR
Mailing Address - Street 2:STE 1
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1426
Mailing Address - Country:US
Mailing Address - Phone:850-729-0303
Mailing Address - Fax:850-729-0305
Practice Address - Street 1:1417 N PARTIN DR
Practice Address - Street 2:STE 1
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1426
Practice Address - Country:US
Practice Address - Phone:850-729-0303
Practice Address - Fax:850-729-0305
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4285103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73605YMedicare PIN