Provider Demographics
NPI:1760454466
Name:ELSISHANS, PHYLLIS (MD)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:ELSISHANS
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 1:2881 HYDE PARK ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3228
Mailing Address - Country:US
Mailing Address - Phone:941-366-5440
Mailing Address - Fax:941-366-5793
Practice Address - Street 1:2881 HYDE PARK ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3228
Practice Address - Country:US
Practice Address - Phone:941-366-5440
Practice Address - Fax:941-366-5793
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84894207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E16198Medicare UPIN
FL17058ZMedicare PIN