MEDICARE: WUBERST E SISAY

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	106S00000X	Behavior Technician	25-504991	TX

General Provider Information

NPI Number	:	1861349953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WUBERST E SISAY

Provider Business Mailing Address
First Line	:	2670 S A W GRIMES BLVD APT 3209
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-2846
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	171 DEEP WOOD DR STE 104
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-4935
Country	:	US
Telephone Number	:	512-910-3251
Fax Number	:

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

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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Directions to “ WUBERST E SISAY ” Practice Location

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