Provider Demographics
NPI:1225711021
Name:BENAVIDES, SOFIA RAQUEL (MSN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SOFIA
Middle Name:RAQUEL
Last Name:BENAVIDES
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 CURRY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1794
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:440 CURRY AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-6704
Practice Address - Country:US
Practice Address - Phone:201-227-1299
Practice Address - Fax:201-227-0077
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR18763500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily