Provider Demographics
NPI:1114391208
Name:TEDESCO, SIERRA (PA-C)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:TEDESCO
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:
Other - Last Name:STULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:713 SCOTTISH MIST TRL
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7027
Mailing Address - Country:US
Mailing Address - Phone:806-928-9974
Mailing Address - Fax:806-928-9974
Practice Address - Street 1:2001 N MACARTHUR BOULEVARD
Practice Address - Street 2:MEDICAL OFFICE BUILDING 1, SUITE 425
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061
Practice Address - Country:US
Practice Address - Phone:469-800-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-30
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant