Provider Demographics
NPI:1457776395
Name:AKALU, SISAY (MD)
Entity Type:Individual
Prefix:
First Name:SISAY
Middle Name:
Last Name:AKALU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SISAY
Other - Middle Name:T
Other - Last Name:AKALU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:130 CENTER WAY
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830
Practice Address - Country:US
Practice Address - Phone:607-936-9971
Practice Address - Fax:607-962-8938
Is Sole Proprietor?:No
Enumeration Date:2014-03-01
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00083562083P0901X, 2083X0100X
NY2960542083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine