Provider Demographics
NPI:1538874722
Name:BENHAMMOU, MOHAMMED SIDI
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:SIDI
Last Name:BENHAMMOU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31405 BEAR POND DR
Mailing Address - Street 2:
Mailing Address - City:SORRENTO
Mailing Address - State:FL
Mailing Address - Zip Code:32776-9726
Mailing Address - Country:US
Mailing Address - Phone:407-501-3380
Mailing Address - Fax:
Practice Address - Street 1:31405 BEAR POND DR
Practice Address - Street 2:
Practice Address - City:SORRENTO
Practice Address - State:FL
Practice Address - Zip Code:32776-9726
Practice Address - Country:US
Practice Address - Phone:407-501-3380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-246414106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician