Provider Demographics
NPI:1982963575
Name:SISLER, STEPHANIE BROOK (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:BROOK
Last Name:SISLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-3734
Mailing Address - Country:US
Mailing Address - Phone:301-533-7060
Mailing Address - Fax:877-766-4406
Practice Address - Street 1:607 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-3734
Practice Address - Country:US
Practice Address - Phone:301-533-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0080154208000000X
WV25826208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics