ANDREW DAVID SISISKY – Nutritionist, NPI 1407637838

ANDREW DAVID SISISKY is a healthcare provider. based in Plantation, Florida. specializing in REGISTERED DIETITIAN OR NUTRITION PROFESSIONAL. They hold a License No. 11028 (FL). The NPI Number for ANDREW DAVID SISISKY is 1407637838

Main info

Male
Sole Proprietor
6 Years Of Experience
Accepts Medicare Assignment
Name
ANDREW DAVID SISISKY
NPI
1407637838
Phone
(305) 710-4457
Address
621 NW 108TH AVE
Enumeration Date
11 October 2023
Last Update Date
11 October 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8778422425
Graduation Year
2020 (6 years ago)
PAC ID
8426581869
Group Practice PAC ID
8022354182
Professional Enrollment ID
I20241024000625
Address ID
PA190023436AM300XXAVEX305
Telehealth
Yes
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness75
Years active:2State licenses:1Digital endpointsOther names

355 REGISTERED DIETITIAN OR NUTRITION PROFESSIONAL in FL

Provider Addresses for ANDREW DAVID SISISKY

  • 621 NW 108TH AVE

    PLANTATION, FL 333241002

    Phone: (305) 710-4457

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-10-24

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20241024000625IRegistered Dietitian Or Nutrition ProfessionalPATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 33324)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 8022354182View full group profile
NameSpecialtyState
Registered Dietitian Or Nutrition ProfessionalPA
Registered Dietitian Or Nutrition ProfessionalPA
-PA
Registered Dietitian Or Nutrition ProfessionalOR
Registered Dietitian Or Nutrition ProfessionalIN
Registered Dietitian Or Nutrition ProfessionalPA
-PA
Registered Dietitian Or Nutrition ProfessionalPA
Registered Dietitian Or Nutrition ProfessionalNJ
Registered Dietitian Or Nutrition ProfessionalPA

Reviews

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Frequently asked questions

Is there an official ID for ANDREW DAVID SISISKY in U.S. healthcare records?
The official identifier for ANDREW DAVID SISISKY is NPI 1407637838.
Would ANDREW DAVID SISISKY appear as active to a payer?
You can treat ANDREW DAVID SISISKY as active for directory purposes; confirm clinical privileges separately.
What kind of doctor is ANDREW DAVID SISISKY?
ANDREW DAVID SISISKY is associated with Nutritionist in the directory — Clinical services aligned with this taxonomy classification.
What practice footprint exists for ANDREW DAVID SISISKY?
Travel planning: use Plantation, Florida as the reference point for ANDREW DAVID SISISKY, then confirm.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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