MEDICARE: YAZDI SIDHWA SA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant	05-107	TX

General Provider Information

NPI Number	:	1205106580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAZDI SIDHWA SA-C

Provider Business Mailing Address
First Line	:	2027 GLENN LAKES LN
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-4432
Country	:	US
Telephone Number	:	281-682-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2027 GLENN LAKES LN
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-4432
Country	:	US
Telephone Number	:	281-682-9800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2012
Last Update Date	:	03/04/2013

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