Provider Demographics
NPI:1518842079
Name:THOMAS, SISILIA (AGNP-C)
Entity type:Individual
Prefix:
First Name:SISILIA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:SISY
Other - Middle Name:
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 LEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-2008
Mailing Address - Country:US
Mailing Address - Phone:978-495-2452
Mailing Address - Fax:
Practice Address - Street 1:6 LEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-2008
Practice Address - Country:US
Practice Address - Phone:978-495-2452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2263665363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology