Provider Demographics
NPI:1336927649
Name:BENJAMIN, SHARON ELISE
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ELISE
Last Name:BENJAMIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10999 RUTGERS LN
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4744
Mailing Address - Country:US
Mailing Address - Phone:317-910-8344
Mailing Address - Fax:
Practice Address - Street 1:2700 DR MARTIN LUTHER KING JR ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-5019
Practice Address - Country:US
Practice Address - Phone:317-931-4300
Practice Address - Fax:317-931-4330
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28251468A163W00000X
IN71015605A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty