Provider Demographics
NPI:1508694340
Name:BENJAMIN, JASMINE TYDREYA
Entity type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:TYDREYA
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 1:817 HILLTOP RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3815
Mailing Address - Country:US
Mailing Address - Phone:757-525-0636
Mailing Address - Fax:
Practice Address - Street 1:6300 GROSSMAN PL APT 9B
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-2050
Practice Address - Country:US
Practice Address - Phone:757-525-0636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)