Provider Demographics
NPI:1417741562
Name:BENJAMIN, ELIJAH MELVIN (LPN)
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:MELVIN
Last Name:BENJAMIN
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6222 SHULL RD
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-1216
Mailing Address - Country:US
Mailing Address - Phone:786-613-9428
Mailing Address - Fax:
Practice Address - Street 1:6222 SHULL RD
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-1216
Practice Address - Country:US
Practice Address - Phone:786-613-9428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH182624164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse