Provider Demographics
NPI:1548745938
Name:STERNISHA, AIDAN KATHLEEN (PA-C)
Entity Type:Individual
Prefix:
First Name:AIDAN
Middle Name:KATHLEEN
Last Name:STERNISHA
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 1:8140 WALNUT HILL LN
Mailing Address - Street 2:STE 308
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4461
Mailing Address - Country:US
Mailing Address - Phone:716-785-9050
Mailing Address - Fax:
Practice Address - Street 1:908 W TERRELL AVE N
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3034
Practice Address - Country:US
Practice Address - Phone:817-820-0427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12223363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant