Provider Demographics
NPI:1023113206
Name:SISAK, RONDA (RDN/LD)
Entity type:Individual
Prefix:
First Name:RONDA
Middle Name:
Last Name:SISAK
Suffix:
Gender:F
Credentials:RDN/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 HIGHLAND RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-5016
Mailing Address - Country:US
Mailing Address - Phone:972-835-9839
Mailing Address - Fax:
Practice Address - Street 1:307 HIGHLAND RIDGE DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-5016
Practice Address - Country:US
Practice Address - Phone:972-835-9839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07194133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
931860OtherREGISTERED DIETITIAN