Provider Demographics
NPI:1952114498
Name:BENEDICT, AMIT SUDHAKAR
Entity type:Individual
Prefix:
First Name:AMIT
Middle Name:SUDHAKAR
Last Name:BENEDICT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2332 SHELDON DR
Mailing Address - Street 2:
Mailing Address - City:ALLEGANY
Mailing Address - State:NY
Mailing Address - Zip Code:14706-9440
Mailing Address - Country:US
Mailing Address - Phone:716-244-7719
Mailing Address - Fax:
Practice Address - Street 1:2332 SHELDON DR
Practice Address - Street 2:
Practice Address - City:ALLEGANY
Practice Address - State:NY
Practice Address - Zip Code:14706-9440
Practice Address - Country:US
Practice Address - Phone:716-244-7719
Practice Address - Fax:716-244-7719
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY406657363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health