Odetta Patricia Benfield
Individual provider Active NPI Licensed Practical Nurse · Bay Shore, NY
NPI 1134701683 · NPPES record last updated Apr 24, 2021
Key facts
- NPI
- 1134701683
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 310986 (NY)
- Practice address
- 1529 Agate St
Bay Shore, NY 11706-2803 - Phone
- (631) 338-2925
- NPI assigned
- Apr 24, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 310986 | NY | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 310986 | NY | Yes |
Addresses
Primary practice location
1529 Agate St
Bay Shore, NY 11706-2803
Mailing address
1529 Agate St
Bay Shore, NY 11706-2803
Phone (631) 338-2925
Other providers in Bay Shore, NY
- Bella Eyewear Inc
- Neil Louis Bellet
- Deborah Belus
- Alex Bendanillo
- Nicole Benfanti
- Alexis Benjamin
- Jacqueline Bentley
- Margaret Berger
- Gayle Bergner-Carey
- Cynthia Berkiw
All providers in Bay Shore, NY · Licensed Practical Nurse in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.