Active NPI
Elisabelle Soriya Sissi De Vandy, PHARMD
- Pharmacotherapy Pharmacist
- Fresno, CA
National Provider Identifier
1134558232
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacotherapy Pharmacist
- License
- 47815
- Practice address
- 740 W Alluvial Ave Ste 101
Fresno, CA 93711-5509 - Phone
- (800) 797-3543
- Fax
- (877) 222-7764
- NPI assigned
- Nov 8, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 47815 | CA | |
| Pharmacotherapy Pharmacist | 1835P1200X | 47815 | CA | Primary |
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 47815 | CA | |
| Oncology Pharmacist | 1835X0200X | 47815 | CA |
Addresses
Primary practice location
740 W Alluvial Ave Ste 101
Fresno, CA 93711-5509
Mailing address
1870 Jefferson St Apt 304
San Francisco, CA 94123-1193
Phone (310) 883-5788
Other names 1
- Dr. Soriya K Ly
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 47815 | CA | MD | Pharmacotherapy Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730160000000",
"number": "1134558232",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1870 JEFFERSON ST APT 304",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941231193",
"telephone_number": "310-883-5788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "740 W ALLUVIAL AVE STE 101",
"city": "FRESNO",
"state": "CA",
"postal_code": "937115509",
"telephone_number": "800-797-3543",
"fax_number": "877-222-7764"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE VANDY",
"first_name": "ELISABELLE",
"middle_name": "SORIYA SISSI",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-11-08",
"last_updated": "2024-10-29",
"certification_date": "2024-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "47815",
"primary": false
},
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "CA",
"license": "47815",
"primary": true
},
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "CA",
"license": "47815",
"primary": false
},
{
"code": "1835X0200X",
"taxonomy_group": "",
"desc": "Pharmacist, Oncology",
"state": "CA",
"license": "47815",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SORIYA",
"last_name": "LY",
"middle_name": "K",
"prefix": "DR.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.