Provider Demographics
NPI:1861953325
Name:SIYAS, SAREENA (MD)
Entity type:Individual
Prefix:
First Name:SAREENA
Middle Name:
Last Name:SIYAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SAREENA
Other - Middle Name:
Other - Last Name:ABOOBACKER ABDULLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:611 E STATE HIGHWAY 121 STE 220
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-7958
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2520 W I 20
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-7280
Practice Address - Country:US
Practice Address - Phone:972-264-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXT9251207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program