Provider Demographics
NPI:1316653827
Name:SISTO, DOROTHY EVA (PA-C)
Entity type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:EVA
Last Name:SISTO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SUNRISE LN
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:NY
Mailing Address - Zip Code:12170-1220
Mailing Address - Country:US
Mailing Address - Phone:518-301-1480
Mailing Address - Fax:
Practice Address - Street 1:13 SUNRISE LN
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:NY
Practice Address - Zip Code:12170-1220
Practice Address - Country:US
Practice Address - Phone:518-301-1480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant