=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225031529
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAMELA C SISNEY DPM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2005
-----------------------------------------------------
Last Update Date | 05/20/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8404 BEECHMONT AVE
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45255-4781
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-474-4450
-----------------------------------------------------
Fax | 513-474-6387
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 418
-----------------------------------------------------
City | BATAVIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45103-0418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-474-4450
-----------------------------------------------------
Fax | 513-474-6387
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 36002320
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------