Provider Demographics
NPI:1275019366
Name:SIVAK, DANA (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:SIVAK
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 E WOODFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4706
Mailing Address - Country:US
Mailing Address - Phone:630-450-7530
Mailing Address - Fax:
Practice Address - Street 1:1037 E WOODFIELD RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4706
Practice Address - Country:US
Practice Address - Phone:847-519-7046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.007442133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered