Provider Demographics
NPI:1235788183
Name:SIROTA, YELENA (OD)
Entity Type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:SIROTA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 PEACHTREE PKWY STE 700
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-6523
Mailing Address - Country:US
Mailing Address - Phone:770-623-8564
Mailing Address - Fax:770-441-1237
Practice Address - Street 1:5151 PEACHTREE PKWY STE 700
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-6523
Practice Address - Country:US
Practice Address - Phone:770-623-8564
Practice Address - Fax:770-441-1237
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003185152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist