Healthcare Provider Details

I. General information

NPI: 1932035904
Provider Name (Legal Business Name): NADIYA DIBENEDETTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 CLAY EDWARDS DR
NORTH KANSAS CITY MO
64116-3220
US

IV. Provider business mailing address

14652 S HALSEY ST
OLATHE KS
66062-9430
US

V. Phone/Fax

Practice location:
  • Phone: 816-691-5215
  • Fax:
Mailing address:
  • Phone: 816-691-5215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number2011010246
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: