Provider Demographics
NPI:1306083530
Name:SIROTKIN, YANA (MA, PHD)
Entity type:Individual
Prefix:DR
First Name:YANA
Middle Name:
Last Name:SIROTKIN
Suffix:
Gender:F
Credentials:MA, PHD
Other - Prefix:DR
Other - First Name:YANA
Other - Middle Name:
Other - Last Name:SEGAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, PHD
Mailing Address - Street 1:968 LAKE PLACIDO CT NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3174
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:968 LAKE PLACIDO CT NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-3174
Practice Address - Country:US
Practice Address - Phone:703-986-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist