Healthcare Provider Details

I. General information

NPI: 1316575442
Provider Name (Legal Business Name): SYDNEY L BENTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11156 CANAL RD
CINCINNATI OH
45241-5815
US

IV. Provider business mailing address

515 DAYTON ST
HAMILTON OH
45011-3455
US

V. Phone/Fax

Practice location:
  • Phone: 513-772-6166
  • Fax:
Mailing address:
  • Phone: 513-868-7654
  • Fax: 513-737-0026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: