Provider Demographics
NPI:1386485605
Name:BENJAMIN, SHYANNA ELIZABETH
Entity type:Individual
Prefix:
First Name:SHYANNA
Middle Name:ELIZABETH
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 1:305 DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-3321
Mailing Address - Country:US
Mailing Address - Phone:567-242-8902
Mailing Address - Fax:
Practice Address - Street 1:305 DEVONSHIRE DR
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-3321
Practice Address - Country:US
Practice Address - Phone:567-242-8902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker