Provider Demographics
NPI:1275504888
Name:SISTO, TODD F (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:F
Last Name:SISTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 S CITRUS AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4701
Mailing Address - Country:US
Mailing Address - Phone:352-344-9400
Mailing Address - Fax:352-344-9086
Practice Address - Street 1:131 S CITRUS AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4701
Practice Address - Country:US
Practice Address - Phone:352-344-9400
Practice Address - Fax:352-344-9086
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62935174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
E89743Medicare UPIN
FL18176ZMedicare ID - Type Unspecified