Provider Demographics
NPI:1295715654
Name:SISTO, DONATO ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:DONATO
Middle Name:ANTONIO
Last Name:SISTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 IRVING AVE
Mailing Address - Street 2:SUITE 640
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-464-6255
Mailing Address - Fax:315-464-6251
Practice Address - Street 1:739 IRVING AVE
Practice Address - Street 2:SUITE 640
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-464-6255
Practice Address - Fax:315-464-6251
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT66653208G00000X
VT042-0014571208G00000X
NH10477208G00000X
NY146019208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3086754Medicaid
NHT400171683Medicare PIN
NHA64956Medicare UPIN
NH3086754Medicaid
MERAILROAD P01467873Medicare PIN
NHRAILROAD P01440651Medicare PIN