Provider Demographics
NPI:1386197101
Name:SISK, DAINA ANN (M ED)
Entity Type:Individual
Prefix:
First Name:DAINA
Middle Name:ANN
Last Name:SISK
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 REID ST
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-1764
Mailing Address - Country:US
Mailing Address - Phone:540-290-2323
Mailing Address - Fax:
Practice Address - Street 1:70 MEDICAL CENTER CIR
Practice Address - Street 2:SUITE 204
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2273
Practice Address - Country:US
Practice Address - Phone:540-332-5790
Practice Address - Fax:540-332-5792
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000355231H00000X
VA2101001177237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist