Healthcare Provider Details

I. General information

NPI: 1013839109
Provider Name (Legal Business Name): SYDNEY ANA DOLORES BENTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PACE PLZ
NEW YORK NY
10038-1598
US

IV. Provider business mailing address

3540 STATE HIGHWAY 30
GLOVERSVILLE NY
12078-6765
US

V. Phone/Fax

Practice location:
  • Phone: 212-346-1200
  • Fax:
Mailing address:
  • Phone: 518-775-3657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number397371361
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: