Provider Demographics
NPI:1033857073
Name:SISAY, SANTA BADEG
Entity type:Individual
Prefix:
First Name:SANTA
Middle Name:BADEG
Last Name:SISAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 E WELLS BRANCH PKWY
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3993
Mailing Address - Country:US
Mailing Address - Phone:571-235-9932
Mailing Address - Fax:
Practice Address - Street 1:4545 FULLER DR STE 325
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6530
Practice Address - Country:US
Practice Address - Phone:972-870-5511
Practice Address - Fax:972-870-5512
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1088909363L00000X
TX2021160672363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner