Provider Demographics
NPI:1346968617
Name:SISCO, DANA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:SISCO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HILL LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-4454
Mailing Address - Country:US
Mailing Address - Phone:973-454-7496
Mailing Address - Fax:
Practice Address - Street 1:257 LAFAYETTE AVE STE 330
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4831
Practice Address - Country:US
Practice Address - Phone:845-533-7125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY432387363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care