Jaclyn Sisskind, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

264529 Issued in NY

Practice address

3448 Route 31
Baldwinsville, NY 13027

Phone

(315) 622-6395

Fax

(315) 622-3298

NPI assigned

May 5, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jsisskind6013@direct.upstate.edu

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

• Pediatric Service Group

  • Pediatrics Physician
  • Syracuse, NY
  • NPI 1770539066

  Single Specialty

  Medicare reassignment NPD
• Child Health Care Associates Practice of Pediatrics

  • Pediatrics Physician
  • East Syracuse, NY
  • NPI 1255463964

  Single Specialty

  NPD (past)
• Suny Health Science Center at Syracuse

  • Pharmacy
  • Syracuse, NY
  • NPI 1306567474
  NPD (past)

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

{
    "created_epoch": "1241481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1629202783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3448 ROUTE 31",
            "city": "BALDWINSVILLE",
            "state": "NY",
            "postal_code": "13027",
            "telephone_number": "315-622-6395",
            "fax_number": "315-622-3298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3448 ROUTE 31",
            "city": "BALDWINSVILLE",
            "state": "NY",
            "postal_code": "13027",
            "telephone_number": "315-622-6395",
            "fax_number": "315-622-3298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SISSKIND",
        "first_name": "JACLYN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-05-05",
        "last_updated": "2024-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "264529",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03495585",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Suzanne D Shapero, DMD
• Amy S Shaw, RN
• Michelle Sheldon, NP
• Shelby Siddall, REGISTERED NURSE
• Silver Fox Senior Social Club Inc
• Amber May Skinner
• Meaghan Anne Sloane, RPH PHARMD
• Dana Corinne Smith, OD
• Kaitlyn Elizabeth Smith, OTR/L
• Mary Louise Smith, RN, BSN

• Pediatrics Physician in Baldwinsville, NY
• Providers in Baldwinsville, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; 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.