Provider Demographics
NPI:1154778348
Name:SISISKY, S. ZACHARY (BCBA)
Entity type:Individual
Prefix:MR
First Name:S.
Middle Name:ZACHARY
Last Name:SISISKY
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 SEMINARY AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-4112
Mailing Address - Country:US
Mailing Address - Phone:804-502-0831
Mailing Address - Fax:
Practice Address - Street 1:3804 SEMINARY AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-4112
Practice Address - Country:US
Practice Address - Phone:804-502-0831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst