MEDICARE: SALLY S BENJAMIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R199621	MA

General Provider Information

NPI Number	:	1437976289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY S BENJAMIN

Provider Business Mailing Address
First Line	:	8243 LONDONDERRY CT
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-5626
Country	:	US
Telephone Number	:	240-510-4431
Fax Number	:

Provider Business Practice Location Address
First Line	:	14460 OLD MILL RD STE 20114460
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-3092
Country	:	US
Telephone Number	:	240-355-5305
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2024
Last Update Date	:	09/23/2024

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Directions to “ SALLY S BENJAMIN ” Practice Location

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