Provider Demographics
NPI:1902429103
Name:PESSETTO, ANNELISA
Entity type:Individual
Prefix:
First Name:ANNELISA
Middle Name:
Last Name:PESSETTO
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 1:3708 JEFFERSON ST STE A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6206
Mailing Address - Country:US
Mailing Address - Phone:512-459-6503
Mailing Address - Fax:512-454-7453
Practice Address - Street 1:3708 JEFFERSON ST STE A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6206
Practice Address - Country:US
Practice Address - Phone:512-459-6503
Practice Address - Fax:512-454-7453
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX709516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine