Provider Demographics
NPI:1639455660
Name:SANFILIPPO, KRISTINA (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:SANFILIPPO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:SCHAEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4520 W 69TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-8148
Mailing Address - Country:US
Mailing Address - Phone:605-977-5000
Mailing Address - Fax:605-977-5377
Practice Address - Street 1:4520 W 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8148
Practice Address - Country:US
Practice Address - Phone:605-977-5000
Practice Address - Fax:605-977-5377
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0003284363A00000X
SD1138363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73183041Medicaid
CO358359YMGXMedicare PIN