Healthcare Provider Details

I. General information

NPI: 1417510967
Provider Name (Legal Business Name): DORIS AKUDAZIE BEN NP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 RITCHIE HWY
BROOKLYN MD
21225-3640
US

IV. Provider business mailing address

5721 RITCHIE HWY
BROOKLYN MD
21225-3640
US

V. Phone/Fax

Practice location:
  • Phone: 585-415-1942
  • Fax: 410-401-0102
Mailing address:
  • Phone: 410-206-3839
  • Fax: 410-401-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR167482
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberR167482
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR167482
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: