Provider Demographics
NPI:1083380539
Name:SISNEROS, SADAY PAULA
Entity Type:Individual
Prefix:
First Name:SADAY
Middle Name:PAULA
Last Name:SISNEROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5606 82ND ST SW APT F305
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-6430
Mailing Address - Country:US
Mailing Address - Phone:253-339-6405
Mailing Address - Fax:
Practice Address - Street 1:1901 S UNION AVE,
Practice Address - Street 2:BUILDING #7, SUITE 6007
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:818-241-6780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician