Provider Demographics
NPI:1861259905
Name:MAHECHA BENITEZ, BRENDA T
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:T
Last Name:MAHECHA BENITEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:T
Other - Last Name:MAHECHA BENITEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:16 PERRY DR
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-7522
Mailing Address - Country:US
Mailing Address - Phone:732-569-8857
Mailing Address - Fax:
Practice Address - Street 1:16 PERRY DR
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7522
Practice Address - Country:US
Practice Address - Phone:732-569-8857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist