Provider Demographics
NPI:1871663435
Name:SIROTA, ROCHELLE AUDREY (MS, RD, CDN)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:AUDREY
Last Name:SIROTA
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E 20TH ST STE 4RW
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1310
Mailing Address - Country:US
Mailing Address - Phone:212-598-9447
Mailing Address - Fax:212-598-9947
Practice Address - Street 1:30 E 20TH ST STE 4RW
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-598-9447
Practice Address - Fax:212-598-9947
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002430133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered