Provider Demographics
NPI:1497868194
Name:SISLEY, SUZANNE ARLENE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:ARLENE
Last Name:SISLEY
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 1:12622 N 81ST ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-5232
Mailing Address - Country:US
Mailing Address - Phone:480-922-9015
Mailing Address - Fax:
Practice Address - Street 1:12622 N 81ST ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5232
Practice Address - Country:US
Practice Address - Phone:480-922-9015
Practice Address - Fax:602-827-2118
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24426207R00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ490368Medicaid
AZ60164Medicare ID - Type Unspecified
AZH07303Medicare UPIN