Healthcare Provider Details

I. General information

NPI: 1174405245
Provider Name (Legal Business Name): ALEXANDRA BENJAMIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 MAIN ST
BUFFALO NY
14214-3001
US

IV. Provider business mailing address

222 MARINEVIEW DR
CHITTENANGO NY
13037-4051
US

V. Phone/Fax

Practice location:
  • Phone: 716-645-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number796773
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number796773
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: