Provider Demographics
NPI:1982149688
Name:SILLAH, MARIAMA
Entity type:Individual
Prefix:
First Name:MARIAMA
Middle Name:
Last Name:SILLAH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 LAVACA ST STE 110-320
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2172
Mailing Address - Country:US
Mailing Address - Phone:512-477-4088
Mailing Address - Fax:
Practice Address - Street 1:1108 LAVACA ST STE 110-320
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2172
Practice Address - Country:US
Practice Address - Phone:512-477-4088
Practice Address - Fax:512-668-9553
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1126622363LF0000X
GARN222814363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty