Provider Demographics
NPI:1114529120
Name:SIDDIQUI, SADAF WASEEM (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SADAF
Middle Name:WASEEM
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22830 SPELLBROOK BEND LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-6395
Mailing Address - Country:US
Mailing Address - Phone:281-768-9326
Mailing Address - Fax:
Practice Address - Street 1:22830 SPELLBROOK BEND LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-6395
Practice Address - Country:US
Practice Address - Phone:281-768-9326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14012363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant