Provider Demographics
NPI:1104364785
Name:SIRAJUDDIN, MARIAH (PA-C, MPAS)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:SIRAJUDDIN
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:
Other - Last Name:SIRAJUDDIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:19414 MAIDENHAIR FERN DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-7991
Mailing Address - Country:US
Mailing Address - Phone:281-202-9290
Mailing Address - Fax:
Practice Address - Street 1:19121 W LITTLE YORK RD STE B
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-5841
Practice Address - Country:US
Practice Address - Phone:713-955-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10796363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant