Provider Demographics
NPI:1457922056
Name:BENITEZ, SULAIMY
Entity type:Individual
Prefix:
First Name:SULAIMY
Middle Name:
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SULAIMY
Other - Middle Name:
Other - Last Name:BENITEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:5812 ADAMS ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-1281
Mailing Address - Country:US
Mailing Address - Phone:786-352-0916
Mailing Address - Fax:
Practice Address - Street 1:5812 ADAMS ST APT 2
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1281
Practice Address - Country:US
Practice Address - Phone:786-352-0916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01161500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily