MEDICARE: MS. MARIANNE TSIKITAS R.D., C.D.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	006106	NY

General Provider Information

NPI Number	:	1346305505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIANNE TSIKITAS R.D., C.D.N.

Provider Business Mailing Address
First Line	:	15 GREYLEDGE DR
Second Line	:
City	:	LOUDONVILLE
State	:	NY
Zip	:	12211-2055
Country	:	US
Telephone Number	:	518-451-9866
Fax Number	:

Provider Business Practice Location Address
First Line	:	326 S PEARL ST
Second Line	:	ST. PETER'S HOSPITAL FAMILY HEALTH CENTER
City	:	ALBANY
State	:	NY
Zip	:	12202-1914
Country	:	US
Telephone Number	:	518-449-0100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/09/2007

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