Provider Demographics
NPI:1720345374
Name:BENYELLA, MARTHA BERINYUY
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:BERINYUY
Last Name:BENYELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:BERINYUY
Other - Last Name:FON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9823 GOOD LUCK RD
Mailing Address - Street 2:APT 12
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3363
Mailing Address - Country:US
Mailing Address - Phone:301-674-9989
Mailing Address - Fax:
Practice Address - Street 1:9823 GOOD LUCK RD
Practice Address - Street 2:APT 12
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3363
Practice Address - Country:US
Practice Address - Phone:301-674-9989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide