Mitra Marvasti-Sitterly

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

13636 Issued in CT

Practice address

381 Hopmeadow St Ste 202
Weatogue, CT 06089-9697

Phone

(860) 658-7548

NPI assigned

Apr 22, 2022

Last updated

Jun 25, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Simsbury Pediatric & Adolescent Dentistry, LLC

  • Pediatric Dentistry
  • Weatogue, CT
  • NPI 1922122332
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1650585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750809600000",
    "number": "1154065514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "181 PARTRIDGE LNDG",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332849",
            "telephone_number": "860-692-8127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "381 HOPMEADOW ST STE 202",
            "city": "WEATOGUE",
            "state": "CT",
            "postal_code": "060899697",
            "telephone_number": "860-658-7548"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21 Bay State Rd",
            "address_purpose": "LOCATION",
            "city": "Chicopee",
            "state": "MA",
            "postal_code": "010201521",
            "country_code": "US",
            "telephone_number": "860-692-8127",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARVASTI-SITTERLY",
        "first_name": "MITRA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-22",
        "last_updated": "2025-06-25",
        "certification_date": "2025-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN1859415",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "13636",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MA",
            "license": "DN1859415",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CT",
            "license": "13636",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CT",
            "license": "13758",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sydney Ladenheim, MD
• Elizabeth Langevin, LCSW
• Live Every Day
• Susan H Lynch, APRN
• Marc J Mann PHD (Marc J Mann PHD, LLC)
• Madelaine Rose McCarthy
• Kaitlyn McIsaac, OT
• Isabela Miani
• Mary Monahan, DPT
• Abigail Mulligan

• Pediatric Dentistry in Weatogue, CT
• Providers in Weatogue, CT by specialty
• Pediatric Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.