Provider Demographics
NPI:1225031529
Name:SISNEY, PAMELA C (DPM)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:C
Last Name:SISNEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 418
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-0418
Mailing Address - Country:US
Mailing Address - Phone:513-474-4450
Mailing Address - Fax:513-474-6387
Practice Address - Street 1:8404 BEECHMONT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-4781
Practice Address - Country:US
Practice Address - Phone:513-474-4450
Practice Address - Fax:513-474-6387
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002320213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0604822Medicaid
OH27-01327OtherUHC
480034631OtherRR MEDICARE
OH000000251385OtherANTHEM
OH27-01327OtherUHC
OH0580936Medicare PIN