Provider Demographics
NPI:1720341282
Name:BENJAMIN-RUSSELL, SHAIRMAIN MARIA
Entity type:Individual
Prefix:MRS
First Name:SHAIRMAIN
Middle Name:MARIA
Last Name:BENJAMIN-RUSSELL
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 1:11562 222ND ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1229
Mailing Address - Country:US
Mailing Address - Phone:718-949-2344
Mailing Address - Fax:
Practice Address - Street 1:11562 222ND ST
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1229
Practice Address - Country:US
Practice Address - Phone:718-949-2344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist