Provider Demographics
NPI:1518621549
Name:SISAY, YODIT D
Entity Type:Individual
Prefix:
First Name:YODIT
Middle Name:D
Last Name:SISAY
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 1:5503 BENNINGTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8902
Mailing Address - Country:US
Mailing Address - Phone:703-899-3281
Mailing Address - Fax:703-899-3281
Practice Address - Street 1:5503 BENNINGTON PARK DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8902
Practice Address - Country:US
Practice Address - Phone:703-899-3281
Practice Address - Fax:703-899-3281
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor