MEDICARE: JEREMIAH SISAY, PHARMD, MD, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1497217145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEREMIAH SISAY, PHARMD, MD, PLLC

Provider Business Mailing Address
First Line	:	2698 N GALLOWAY AVE STE 101
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75150-6384
Country	:	US
Telephone Number	:	972-288-1662
Fax Number	:	972-289-3075

Provider Business Practice Location Address
First Line	:	2698 N GALLOWAY AVE STE 101
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75150-6384
Country	:	US
Telephone Number	:	972-288-1662
Fax Number	:	972-289-3075

Authorized Official
Title or Position	:	OWNER
Name	:	JEREMIAH SISAY
Credential	:	MD
Telephone Number	:	972-288-1662

Provider Enumeration Date	:	04/02/2019
Last Update Date	:	01/29/2026

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