Healthcare Provider Details

I. General information

NPI: 1477489375
Provider Name (Legal Business Name): JULIANA KOSTYUK SIRODAN AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MEDICAL PLAZA DR STE 220
ROSEVILLE CA
95661-3088
US

IV. Provider business mailing address

5918 RYE WAY
CARMICHAEL CA
95608-1014
US

V. Phone/Fax

Practice location:
  • Phone: 916-773-7290
  • Fax:
Mailing address:
  • Phone: 510-460-8898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number4133
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: