Provider Demographics
NPI:1457594020
Name:VON SITAS, KATJA A (PA)
Entity Type:Individual
Prefix:MS
First Name:KATJA
Middle Name:A
Last Name:VON SITAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-9701
Mailing Address - Country:US
Mailing Address - Phone:802-878-1008
Mailing Address - Fax:802-872-2679
Practice Address - Street 1:1775 WILLISTON RD STE 110
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6491
Practice Address - Country:US
Practice Address - Phone:877-698-8496
Practice Address - Fax:802-862-9637
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055-00300963363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT055-00300963OtherSTATE PA CERTIFICATION