Provider Demographics
NPI:1831413731
Name:TISEO, SANDRA ANN (PAC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANN
Last Name:TISEO
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 S EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1562
Mailing Address - Country:US
Mailing Address - Phone:215-504-9255
Mailing Address - Fax:215-504-9260
Practice Address - Street 1:2950 S EAGLE RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1562
Practice Address - Country:US
Practice Address - Phone:215-504-9255
Practice Address - Fax:215-504-9260
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA000922363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant