Provider Demographics
NPI:1346413002
Name:BENJAMIN, SOPHIYA (MBBS)
Entity type:Individual
Prefix:
First Name:SOPHIYA
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4404 DULA ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-1668
Mailing Address - Country:US
Mailing Address - Phone:919-806-6282
Mailing Address - Fax:
Practice Address - Street 1:DDSP DEPT OF PSYCHIATRY
Practice Address - Street 2:BOX 3837
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-806-6282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC134796390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program