Healthcare Provider Details

I. General information

NPI: 1346392800
Provider Name (Legal Business Name): SIAN CHISHOLM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1747 BAPTIST CLAY DR STE 300
FLEMING ISLAND FL
32003-8503
US

IV. Provider business mailing address

4800 BELFORT RD
JACKSONVILLE FL
32256-6004
US

V. Phone/Fax

Practice location:
  • Phone: 904-214-8100
  • Fax: 904-214-8109
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME99207
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: