License Verification

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MILES CLARK BENNETT

License Number: OS10955

Data As Of 12/2/2024

Profession
Osteopathic Physician
License
OS10955
License Status
CLEAR/Active
License Expiration Date
3/31/2026
License Original Issue Date
05/07/2010
Address of Record
500 WINDERLEY PLACE
SUITE #115
MAITLAND, FL 32751
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No

No secondary locations found.


Name Relationship Profession License Effective Date
BARDITA, CRISTINA Supervisor Medical Doctor 149352 04/15/2021
DAWKINS, DONALD Supervising Prescribing Practitioner Osteopathic Physician 10160 08/31/2021
GONG, LEI Supervising Prescribing Practitioner Medical Doctor 144882 07/28/2020
GONG, LEI Supervisor Medical Doctor 144882 07/01/2020

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Name Relationship Profession License Effective Date
BRIDGE, LAUREN ELIZABETH Prescribing Physician Assistant Medical Doctor 118630 6/10/2022
BURCHENSON, KRYSTA-GAYE LATOYA Prescribing Physician Assistant Physician Assistant 9108009 3/27/2018
GRAHAM, KELLY ANN Prescribing Physician Assistant Physician Assistant 9112573 10/23/2019
HABIB, LAILA NICOLE Prescribing Physician Assistant Physician Assistant 9111509 12/17/2018
LUKASIK, MICHELLE NICOLE Prescribing Physician Assistant Physician Assistant 9111603 12/17/2018
PATTANI, SANJAY J Prescribing Physician Assistant Medical Doctor 107131 6/10/2022
SIROTKIN, LEELA STELLA Prescribing Physician Assistant Medical Doctor 106409 6/10/2022

Click on the License Number to view License Details for that Practitioner

Name Relationship Profession License Effective Date

Click on the License Number to view License Details for that Practitioner



No Continuing Education Hours Received from Approved Providers As Of 12/2/2024



* To find out more about Approved Providers, or ask a provider why the course you took is not yet listed, please visit our Continuing Education Providers page.


** Personal Development is limited to no more than 3 hours per renewal cycle. Any personal development hours in excess of this 3 hour maximum cannot be used for renewal and have been subtracted from the total available for renewal.


Please do not fax proof of Continuing Education hours to the Board Office until you have received your renewal notice in the mail.


For instructions on how to request a license certification of your Florida license to be sent to another state from the Florida Department of Health, please visit the License Certifications web page.