Provider Demographics
NPI:1811534076
Name:SIDERKO, ALISON C (RDN)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:C
Last Name:SIDERKO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 LILINOE PL
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8575
Mailing Address - Country:US
Mailing Address - Phone:908-812-2646
Mailing Address - Fax:
Practice Address - Street 1:31 LILINOE PL
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8575
Practice Address - Country:US
Practice Address - Phone:908-812-2646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered