Provider Demographics
NPI:1790674166
Name:SISSON, DEBORAH ANN (MS RDN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:SISSON
Suffix:
Gender:X
Credentials:MS RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BURRWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-7809
Mailing Address - Country:US
Mailing Address - Phone:617-480-2840
Mailing Address - Fax:
Practice Address - Street 1:16 BURRWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-7809
Practice Address - Country:US
Practice Address - Phone:617-480-2840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN923133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered