Provider Demographics
NPI:1154857159
Name:AHSANUDDIN, SAYEEDA (MD)
Entity type:Individual
Prefix:
First Name:SAYEEDA
Middle Name:
Last Name:AHSANUDDIN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 E HILL ST
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-2470
Mailing Address - Country:US
Mailing Address - Phone:646-463-2070
Mailing Address - Fax:
Practice Address - Street 1:4949 GOLDEN TRIANGLE BLVD STE 611
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4456
Practice Address - Country:US
Practice Address - Phone:817-898-2188
Practice Address - Fax:817-439-6055
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.141904207N00000X
TXV3545207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty