Provider Demographics
NPI:1114617289
Name:SILLAH, HADDY (FNP)
Entity Type:Individual
Prefix:
First Name:HADDY
Middle Name:
Last Name:SILLAH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 COLCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76134-2119
Mailing Address - Country:US
Mailing Address - Phone:678-790-9653
Mailing Address - Fax:
Practice Address - Street 1:1011 ROBERTS CUT OFF RD
Practice Address - Street 2:
Practice Address - City:RIVER OAKS
Practice Address - State:TX
Practice Address - Zip Code:76114-2814
Practice Address - Country:US
Practice Address - Phone:817-626-9744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1117015363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily