MEDICARE: BEHNAZ MODARESI RN

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	363L00000X	Nurse Practitioner	APRN11045780	FL
2	163WM0705X	Medical-Surgical Registered Nurse	RN9522827	FL

General Provider Information

NPI Number	:	1790370708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEHNAZ MODARESI RN

Provider Business Mailing Address
First Line	:	5360 ROCKING HORSE PL
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-6128
Country	:	US
Telephone Number	:	407-985-6775
Fax Number	:

Provider Business Practice Location Address
First Line	:	5360 ROCKING HORSE PL
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-6128
Country	:	US
Telephone Number	:	407-985-6775
Fax Number	:

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

Provider Enumeration Date	:	03/02/2021
Last Update Date	:	03/10/2026

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