Provider Demographics
NPI:1396535845
Name:SIKSNAITE, AGNE (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:AGNE
Middle Name:
Last Name:SIKSNAITE
Suffix:
Gender:X
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15W305 91ST ST
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6380
Mailing Address - Country:US
Mailing Address - Phone:630-999-6483
Mailing Address - Fax:
Practice Address - Street 1:15W305 91ST ST
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-6380
Practice Address - Country:US
Practice Address - Phone:630-999-6483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered