Provider Demographics
NPI:1538860630
Name:AYIDIYA, BENEDICTA (RN)
Entity type:Individual
Prefix:
First Name:BENEDICTA
Middle Name:
Last Name:AYIDIYA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 NASA PKWY STE 620
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2818
Mailing Address - Country:US
Mailing Address - Phone:346-531-9445
Mailing Address - Fax:346-358-0252
Practice Address - Street 1:1120 NASA PKWY STE 620
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2818
Practice Address - Country:US
Practice Address - Phone:346-531-9445
Practice Address - Fax:346-358-0252
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX932071163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse