Provider Demographics
NPI:1851073571
Name:BENJAMIN, KAYLYN MARIE
Entity Type:Individual
Prefix:
First Name:KAYLYN
Middle Name:MARIE
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20830 PRIDAY AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-2619
Mailing Address - Country:US
Mailing Address - Phone:216-563-2817
Mailing Address - Fax:
Practice Address - Street 1:20830 PRIDAY AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-2619
Practice Address - Country:US
Practice Address - Phone:216-563-2817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide