Healthcare Provider Details

I. General information

NPI: 1124038161
Provider Name (Legal Business Name): SHARON RACHEL PINARD-SISLE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARON S ANDERSON RD

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 HOSPITAL DR
ST JOHNSBURY VT
05819-9210
US

IV. Provider business mailing address

1315 HOSPITAL DR PO BOX 905
ST JOHNSBURY VT
05819-9210
US

V. Phone/Fax

Practice location:
  • Phone: 802-748-8141
  • Fax:
Mailing address:
  • Phone: 802-748-8141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number074.0000177
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: