Provider Demographics
NPI:1457620791
Name:BENYA, SHERI ANN (RN)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:ANN
Last Name:BENYA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 JOSEPH WILLETTS DR SE
Mailing Address - Street 2:
Mailing Address - City:WINNABOW
Mailing Address - State:NC
Mailing Address - Zip Code:28479-5047
Mailing Address - Country:US
Mailing Address - Phone:910-264-6213
Mailing Address - Fax:910-253-6214
Practice Address - Street 1:800 JOSEPH WILLETTS DR SE
Practice Address - Street 2:
Practice Address - City:WINNABOW
Practice Address - State:NC
Practice Address - Zip Code:28479-5047
Practice Address - Country:US
Practice Address - Phone:910-264-6213
Practice Address - Fax:910-253-6214
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-010-077320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities