MEDICARE: SAYEEDA AHSANUDDIN MD

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	207N00000X	Dermatology Physician	35.141904	OH
2	207N00000X	Dermatology Physician	V3545	TX

General Provider Information

NPI Number	:	1154857159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAYEEDA AHSANUDDIN MD

Provider Business Mailing Address
First Line	:	743 E HILL ST
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-2470
Country	:	US
Telephone Number	:	646-463-2070
Fax Number	:

Provider Business Practice Location Address
First Line	:	4949 GOLDEN TRIANGLE BLVD STE 611
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4456
Country	:	US
Telephone Number	:	817-898-2188
Fax Number	:	817-439-6055

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

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	04/05/2025

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