Provider Demographics
NPI:1578930624
Name:BENSLEY, ALYCIA M (FNP)
Entity Type:Individual
Prefix:
First Name:ALYCIA
Middle Name:M
Last Name:BENSLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ALYCIA
Other - Middle Name:M
Other - Last Name:MULLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:169 RIVERSIDE DR
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4246
Mailing Address - Country:US
Mailing Address - Phone:607-798-5111
Mailing Address - Fax:607-584-5521
Practice Address - Street 1:4102 VESTAL ROAD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2003
Practice Address - Country:US
Practice Address - Phone:607-352-1735
Practice Address - Fax:607-352-7136
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0339821363L00000X
NY339821363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily