Provider Demographics
NPI:1255106878
Name:SIUDA, ASHLEY MARIE (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:MARIE
Last Name:SIUDA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:MARIE
Other - Last Name:AMATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1419 WORTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1741
Mailing Address - Country:US
Mailing Address - Phone:440-533-5044
Mailing Address - Fax:
Practice Address - Street 1:595 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4681
Practice Address - Country:US
Practice Address - Phone:415-800-2311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-24
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10272133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered