MEDICARE: ATIYA BEGUM MODAK

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	363LA2200X	Adult Health Nurse Practitioner	1192460	TX
2	363LP2300X	Primary Care Nurse Practitioner	1192460	TX
3	363LW0102X	Women's Health Nurse Practitioner	1192460	TX
4	363LC1500X	Community Health Nurse Practitioner	1192460	TX
5	363LG0600X	Gerontology Nurse Practitioner	1192460	TX
6	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	1192460	TX
7	363LX0106X	Occupational Health Nurse Practitioner	1192460	TX
8	363LF0000X	Family Nurse Practitioner	1192460	TX

General Provider Information

NPI Number	:	1366243701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATIYA BEGUM MODAK

Provider Business Mailing Address
First Line	:	414 BIRCH LN
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75081-5526
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 BIRCH LN
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75081-5526
Country	:	US
Telephone Number	:	929-282-8881
Fax Number	:

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

Provider Enumeration Date	:	03/21/2025
Last Update Date	:	03/21/2025

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Directions to “ ATIYA BEGUM MODAK ” Practice Location

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