Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 16313 | NV |
NPI | 1083962278 |
---|---|
Provider Name | Jessica M Sisto |
First Address | South Burlington, VT 05403-6491 |
Second Address | South Burlington, VT 05403-6491 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2012 |
Last Update Date | 11/12/2020 |