Healthcare Provider Details

I. General information

NPI: 1871394601
Provider Name (Legal Business Name): ESHAL SIDDIQUI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11820 CYPRESS CORNER LN
HOUSTON TX
77065-1132
US

IV. Provider business mailing address

8302 ENCINITAS COVE DR
TOMBALL TX
77375-4727
US

V. Phone/Fax

Practice location:
  • Phone: 281-894-1423
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: