Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Fardowsa Shariff Idris, PHYSICIANASSISTANT

Individual provider Physician Assistant · NPI 1609419225

Fardowsa Shariff Idris, PHYSICIANASSISTANT is a Physician Assistant in Tualatin, Oregon. Qualified in 2020, 6 years ago. Practices with Sound Pain Alliance, a 44-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Oregon.

Years since qualifying
6
Licensed in
OR
In the registry since
2019
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

19255 SW 65th Ave Ste 200
Tualatin, OR 97062-9712
Phone: (503) 828-1150
Fax: (503) 828-1160
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 202128 (OR)

Record details

NPI number1609419225
Entity typeIndividual (Type 1)
GenderFemale
Credentials PHYSICIANASSISTANT
Sole proprietorYes
NPI enumeratedOctober 27, 2019
Last updated in NPPESDecember 11, 2020
Certification dateDecember 11, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Sound Pain Alliance — 44 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations4 on file with Medicare

Other providers in Tualatin