Provider Demographics
NPI:1891168431
Name:SISK, HEATHER KATHLEEN (ANAPLASTOLOGIST)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:KATHLEEN
Last Name:SISK
Suffix:
Gender:F
Credentials:ANAPLASTOLOGIST
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:730 PELHAM RD APT 5E
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-1017
Mailing Address - Country:US
Mailing Address - Phone:917-561-0141
Mailing Address - Fax:
Practice Address - Street 1:333 CAMINO GARDENS BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5824
Practice Address - Country:US
Practice Address - Phone:917-561-0141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes229N00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersAnaplastologist