Healthcare Provider Details

I. General information

NPI: 1417849407
Provider Name (Legal Business Name): PARISA MAESUMI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 PARK BEND DR
AUSTIN TX
78758-5072
US

IV. Provider business mailing address

PO BOX 844658
DALLAS TX
75284-4658
US

V. Phone/Fax

Practice location:
  • Phone: 512-220-5401
  • Fax:
Mailing address:
  • Phone: 800-994-0371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19498
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: