Healthcare Provider Details

I. General information

NPI: 1740997550
Provider Name (Legal Business Name): AISHA SIDDIQUI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6903 BRISBANE CT STE 100
SUGAR LAND TX
77479-6845
US

IV. Provider business mailing address

2323 N CENTRAL EXPY # 1000
RICHARDSON TX
75080-2712
US

V. Phone/Fax

Practice location:
  • Phone: 832-886-4774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17789
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: