Provider Demographics
NPI:1477764207
Name:COSSIO, SISSI (MD)
Entity Type:Individual
Prefix:
First Name:SISSI
Middle Name:
Last Name:COSSIO
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 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:954-315-5780
Mailing Address - Fax:954-346-4182
Practice Address - Street 1:7605 N STATE RD 7
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067
Practice Address - Country:US
Practice Address - Phone:954-315-5780
Practice Address - Fax:954-346-4182
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME946312080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262753150OtherTAX ID
FL000861000Medicaid