Provider Demographics
NPI:1780309229
Name:SICINSKI, EMILY MARIE (MS, RDN, CDN)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:MARIE
Last Name:SICINSKI
Suffix:
Gender:F
Credentials:MS, RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 NORTHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-1821
Mailing Address - Country:US
Mailing Address - Phone:631-942-6263
Mailing Address - Fax:
Practice Address - Street 1:428 ROUTE 25A BLDG A
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2514
Practice Address - Country:US
Practice Address - Phone:631-509-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011098133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered