=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609747120
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAGE PSYCHIATRY ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2025
-----------------------------------------------------
Last Update Date | 12/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17610 PRESTON RD STE 1
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75252-5734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-715-5165
-----------------------------------------------------
Fax | 469-568-9191
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17610 PRESTON RD STE 1
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75252-5734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-715-4165
-----------------------------------------------------
Fax | 469-568-9191
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIST/OWNER
-----------------------------------------------------
Name | IMAAN ALAIDROOS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 469-715-4165
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------