Provider Demographics
NPI:1073170148
Name:BENVENUTO, ASHLEY M (NP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:BENVENUTO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 BEDFORD AVENUE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306
Mailing Address - Country:US
Mailing Address - Phone:646-642-2742
Mailing Address - Fax:
Practice Address - Street 1:501 SEAVIEW AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3400
Practice Address - Country:US
Practice Address - Phone:718-226-4940
Practice Address - Fax:718-226-4945
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342724363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily