Provider Demographics
NPI:1831147016
Name:SISITKI, WILLIAM L JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:L
Last Name:SISITKI
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 100707
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-6626
Mailing Address - Country:US
Mailing Address - Phone:786-594-6880
Mailing Address - Fax:814-234-2888
Practice Address - Street 1:91550 OVERSEAS HWY STE 214
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2513
Practice Address - Country:US
Practice Address - Phone:305-271-9777
Practice Address - Fax:814-234-2888
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111083363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P13867Medicare UPIN
PA095486Medicare ID - Type Unspecified