Provider Demographics
NPI:1588343255
Name:SIDRA HEALTHCARE LLC
Entity type:Organization
Organization Name:SIDRA HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:UBAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GAANI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:253-642-4104
Mailing Address - Street 1:4219 S OTHELLO ST # 105F
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3892
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:206-673-8050
Practice Address - Street 1:4219 S OTHELLO ST # 105F
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3892
Practice Address - Country:US
Practice Address - Phone:206-910-0667
Practice Address - Fax:206-673-8050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty