Provider Demographics
NPI:1982082061
Name:SISCO, AIDA NANCY (RDN, LND, DYSC, DEPR)
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:NANCY
Last Name:SISCO
Suffix:
Gender:F
Credentials:RDN, LND, DYSC, DEPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 CALLE ZIRCONIA
Mailing Address - Street 2:URB.LAMELA
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-2378
Mailing Address - Country:US
Mailing Address - Phone:787-242-2193
Mailing Address - Fax:
Practice Address - Street 1:CARR 112 KM 1.4 INT
Practice Address - Street 2:AVE AGUSTIN RAMOS CALERO HOSPITAL CIMA DE ISABELA
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-0979
Practice Address - Country:US
Practice Address - Phone:787-242-2835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1612133N00000X
PR1019815133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist