Provider Demographics
NPI:1841773553
Name:SIROTA, BELLA (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:BELLA
Middle Name:
Last Name:SIROTA
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 BROOKLYN AVE APT 2F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-4446
Mailing Address - Country:US
Mailing Address - Phone:347-446-6341
Mailing Address - Fax:
Practice Address - Street 1:440 BROOKLYN AVE APT 2F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-4446
Practice Address - Country:US
Practice Address - Phone:347-446-6341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-09
Last Update Date:2018-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022372-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant