Provider Demographics
NPI:1811961485
Name:SISSON, JOSIE (PA)
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:
Last Name:SISSON
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 1:6300 POWERS RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-3216
Mailing Address - Country:US
Mailing Address - Phone:716-667-3200
Mailing Address - Fax:716-667-3120
Practice Address - Street 1:6300 POWERS RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-3216
Practice Address - Country:US
Practice Address - Phone:716-667-3200
Practice Address - Fax:716-667-3120
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066555363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000570271003OtherBC/BS
NY00026532802OtherUNIVERA
NY02430793Medicaid
NY9512300OtherIHA
NY02430793Medicaid
NY9512300OtherIHA