Provider Demographics
NPI:1336832971
Name:BENTON, BRANDON REED (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:REED
Last Name:BENTON
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 SARATOGA AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-2621
Mailing Address - Country:US
Mailing Address - Phone:814-771-9434
Mailing Address - Fax:
Practice Address - Street 1:40 FLATBUSH AVENUE EXT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-2903
Practice Address - Country:US
Practice Address - Phone:212-271-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV116304363LF0000X
NY352633363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily