Provider Demographics
NPI:1952076838
Name:SADRUDDIN, ANMOL R (PA-C)
Entity Type:Individual
Prefix:
First Name:ANMOL
Middle Name:R
Last Name:SADRUDDIN
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 1:10409 CAMBRIA COAST RUN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4992
Mailing Address - Country:US
Mailing Address - Phone:512-669-2793
Mailing Address - Fax:
Practice Address - Street 1:10409 CAMBRIA COAST RUN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-4992
Practice Address - Country:US
Practice Address - Phone:512-669-2793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14735363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant