Healthcare Provider Details

I. General information

NPI: 1851755599
Provider Name (Legal Business Name): SADIA KHAN MS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8112 SPRING VALLEY RD
DALLAS TX
75240-3829
US

IV. Provider business mailing address

122 W JOHN CARPENTER FWY STE 420
IRVING TX
75039-2014
US

V. Phone/Fax

Practice location:
  • Phone: 214-884-1705
  • Fax: 214-884-1711
Mailing address:
  • Phone: 972-957-3000
  • Fax: 972-957-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10437
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: