Provider Demographics
NPI:1083962278
Name:SISTO, JESSICA M (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:SISTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 WILLISTON RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6491
Mailing Address - Country:US
Mailing Address - Phone:802-735-1252
Mailing Address - Fax:802-862-9637
Practice Address - Street 1:1775 WILLISTON RD STE 110
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6491
Practice Address - Country:US
Practice Address - Phone:802-735-1252
Practice Address - Fax:802-862-9637
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16313207VX0000X
VT042.0014043207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV114012Medicare PIN