Provider Demographics
NPI:1225322845
Name:SISTI, RYAN M
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:M
Last Name:SISTI
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 1:8523 PROMONTORY RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-9277
Mailing Address - Country:US
Mailing Address - Phone:574-360-3049
Mailing Address - Fax:
Practice Address - Street 1:8523 PROMONTORY RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-9277
Practice Address - Country:US
Practice Address - Phone:574-360-3049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist