Healthcare Provider Details

I. General information

NPI: 1538506217
Provider Name (Legal Business Name): DANIELLE LYNN SIEKIERSKI RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6136 BRANDON AVE
SPRINGFIELD VA
22150-2610
US

IV. Provider business mailing address

644 MASSACHUSETTS AVE NE APT 303
WASHINGTON DC
20002-6069
US

V. Phone/Fax

Practice location:
  • Phone: 703-866-3131
  • Fax:
Mailing address:
  • Phone: 704-996-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1079293
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: