Provider Demographics
NPI:1467014449
Name:POLISTICO, SARAH MELISSA AGBADA (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH MELISSA
Middle Name:AGBADA
Last Name:POLISTICO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SARAH MELISSA
Other - Middle Name:BARBONO
Other - Last Name:AGBADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2022 KELLE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-8708
Mailing Address - Country:US
Mailing Address - Phone:219-364-4004
Mailing Address - Fax:
Practice Address - Street 1:1509 STATE ST
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3115
Practice Address - Country:US
Practice Address - Phone:219-324-3431
Practice Address - Fax:219-362-3802
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN01085776A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program