Healthcare Provider Details

I. General information

NPI: 1962334458
Provider Name (Legal Business Name): MR. SISNIOS ABEBE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 DALLAS PKWY STE 210
PLANO TX
75024-4181
US

IV. Provider business mailing address

6201 DALLAS PKWY STE 210
PLANO TX
75024-4181
US

V. Phone/Fax

Practice location:
  • Phone: 972-947-2447
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: