Provider Demographics
NPI:1679179634
Name:SAYSAY, BENJAMIN SAA (FNP)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:SAA
Last Name:SAYSAY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PULLER PL
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-8613
Mailing Address - Country:US
Mailing Address - Phone:571-383-7944
Mailing Address - Fax:
Practice Address - Street 1:451 W MILHAM AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-2721
Practice Address - Country:US
Practice Address - Phone:269-488-9008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017146798363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily