Provider Demographics
NPI:1780483172
Name:MOHAMMAD SADIQ, SAHAR
Entity type:Individual
Prefix:
First Name:SAHAR
Middle Name:
Last Name:MOHAMMAD SADIQ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SAHAR
Other - Middle Name:
Other - Last Name:MOHAMMAD SADIQ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:22831 SE FIR ST
Mailing Address - Street 2:
Mailing Address - City:BLACK DIAMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98010-5082
Mailing Address - Country:US
Mailing Address - Phone:206-610-9292
Mailing Address - Fax:
Practice Address - Street 1:315 M.L.K. JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-403-8327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATA61615665363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical