Provider Demographics
NPI:1578830089
Name:BENEVIDES, SHERI-RYAN A (APRN)
Entity Type:Individual
Prefix:
First Name:SHERI-RYAN
Middle Name:A
Last Name:BENEVIDES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:SUITE 416
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-947-8500
Mailing Address - Fax:860-524-8643
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 416
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-947-8500
Practice Address - Fax:860-524-8643
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4816363LF0000X
CT004816363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT061200871OtherUNITED HEALTHCARE
CT061200871OtherTRICARE
CT104816OtherCONNECTICARE
CT9862826OtherAETNA
CT9862826OtherAETNA