Provider Demographics
NPI:1134339732
Name:SACKETT, JILLAN CANTOR (MD, MS)
Entity type:Individual
Prefix:DR
First Name:JILLAN
Middle Name:CANTOR
Last Name:SACKETT
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BEAR CREEK LN
Mailing Address - Street 2:
Mailing Address - City:WATERBURY CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05677-8332
Mailing Address - Country:US
Mailing Address - Phone:215-292-5146
Mailing Address - Fax:
Practice Address - Street 1:207 WEBSTER RD
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-6533
Practice Address - Country:US
Practice Address - Phone:215-292-5146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1906012084P0800X, 2084P0804X
PAMD4384192084P0804X
VT042.00167312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry