Provider Demographics
NPI:1649989765
Name:DIBENEDETTO, TERESA (FNP)
Entity type:Individual
Prefix:MISS
First Name:TERESA
Middle Name:
Last Name:DIBENEDETTO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7914 ROCKAWAY BEACH BLVD APT 6A
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11693-2081
Mailing Address - Country:US
Mailing Address - Phone:646-208-7744
Mailing Address - Fax:
Practice Address - Street 1:7914 ROCKAWAY BEACH BLVD APT 6A
Practice Address - Street 2:
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693-2081
Practice Address - Country:US
Practice Address - Phone:646-208-7744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349107363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner