Provider Demographics
NPI:1902877954
Name:SATINK, PHYLLIS A (MS, APRN, CS)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:A
Last Name:SATINK
Suffix:
Gender:F
Credentials:MS, APRN, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 POKER HILL RD
Mailing Address - Street 2:
Mailing Address - City:UNDERHILL
Mailing Address - State:VT
Mailing Address - Zip Code:05489-9383
Mailing Address - Country:US
Mailing Address - Phone:802-373-1386
Mailing Address - Fax:877-852-2315
Practice Address - Street 1:425 POKER HILL RD
Practice Address - Street 2:
Practice Address - City:UNDERHILL
Practice Address - State:VT
Practice Address - Zip Code:05489-9383
Practice Address - Country:US
Practice Address - Phone:802-373-1386
Practice Address - Fax:877-852-2315
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-29
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0008503364SP0809X, 364SP0808X, 364SP0809X
VT068-0000082101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0NP0504Medicaid
VTNP0504Medicare ID - Type UnspecifiedADVANCED PRACTICE NURSE