Provider Demographics
NPI:1396116810
Name:BEGUM, AMENA (PA)
Entity type:Individual
Prefix:
First Name:AMENA
Middle Name:
Last Name:BEGUM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8921 ELMHURST AVE
Mailing Address - Street 2:APT 520
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1544
Mailing Address - Country:US
Mailing Address - Phone:646-255-2864
Mailing Address - Fax:
Practice Address - Street 1:8921 ELMHURST AVE
Practice Address - Street 2:APT 520
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1544
Practice Address - Country:US
Practice Address - Phone:646-255-2864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019069363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical