Provider Demographics
NPI:1114391208
Name:TEDESCO, SIERRA (PA-C)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:TEDESCO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:
Other - Last Name:STULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3505 ASHMERE LOOP
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-1013
Mailing Address - Country:US
Mailing Address - Phone:806-928-9974
Mailing Address - Fax:
Practice Address - Street 1:300 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1032
Practice Address - Country:US
Practice Address - Phone:512-509-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-30
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant