Provider Demographics
NPI:1790370708
Name:MODARESI, BEHNAZ (RN)
Entity Type:Individual
Prefix:
First Name:BEHNAZ
Middle Name:
Last Name:MODARESI
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 1:5360 ROCKING HORSE PL
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6128
Mailing Address - Country:US
Mailing Address - Phone:407-985-6775
Mailing Address - Fax:
Practice Address - Street 1:5360 ROCKING HORSE PL
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6128
Practice Address - Country:US
Practice Address - Phone:407-985-6775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9522827163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical