Provider Demographics
NPI:1497067441
Name:BENSON, SHERMIYA DEANDRA (LPN)
Entity Type:Individual
Prefix:MS
First Name:SHERMIYA
Middle Name:DEANDRA
Last Name:BENSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2279 NICOLE DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-6273
Mailing Address - Country:US
Mailing Address - Phone:678-610-0330
Mailing Address - Fax:
Practice Address - Street 1:2279 NICOLE DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-6273
Practice Address - Country:US
Practice Address - Phone:678-610-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN072729374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide