Healthcare Provider Details

I. General information

NPI: 1730471624
Provider Name (Legal Business Name): MAYUMI OKUDA BENAVIDES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 05/21/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 475 BOX 1
FPO AP
96350-1200
US

IV. Provider business mailing address

PSC 475 BOX 1
FPO AP
96350-1200
US

V. Phone/Fax

Practice location:
  • Phone: 646-397-1520
  • Fax:
Mailing address:
  • Phone: 646-397-1520
  • Fax: 646-786-4398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number273005
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: