Healthcare Provider Details

I. General information

NPI: 1831286814
Provider Name (Legal Business Name): BEENA NAZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BEENA AHMAD M.D

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4882 QUALITY TRAIL
ORLANDO FL
32829
US

IV. Provider business mailing address

PO BOX 677879
ORLANDO FL
32867-7879
US

V. Phone/Fax

Practice location:
  • Phone: 407-440-3004
  • Fax: 407-429-3899
Mailing address:
  • Phone: 407-440-3004
  • Fax: 407-429-3899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME96299
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: