Provider Demographics
NPI:1346305505
Name:TSIKITAS, MARIANNE (RD, CDN)
Entity Type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:
Last Name:TSIKITAS
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GREYLEDGE DR
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12211-2055
Mailing Address - Country:US
Mailing Address - Phone:518-451-9866
Mailing Address - Fax:
Practice Address - Street 1:326 S PEARL ST
Practice Address - Street 2:ST. PETER'S HOSPITAL FAMILY HEALTH CENTER
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12202-1914
Practice Address - Country:US
Practice Address - Phone:518-449-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006106133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMT0239Medicare PIN