Individual provider Active NPI

Iryna Korniyenko Yelisetty, D.M.D, M.S.D.

  • Endodontics
  • Lutz, FL
National Provider Identifier
1225310592
Registry record updated Feb 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
DN28893 Issued in FL
Practice address
17512 Radiant Shine Way
Lutz, FL 33558-5735
Phone
(251) 458-4334
NPI assigned
Sep 13, 2011
Last updated
Feb 19, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X DN28893 FL Primary

Addresses

Primary practice location

17512 Radiant Shine Way
Lutz, FL 33558-5735

Mailing address

1475 Peachtree Pkwy Ste C3
Cumming, GA 30041-9793
Phone (470) 253-1747

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DN28893FLMDEndodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Smiles Dentistry Cumming PC PastSince Jul 4, 2021 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739923200000",
    "number": "1225310592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1475 PEACHTREE PKWY STE C3",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300419793",
            "telephone_number": "470-253-1747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17512 RADIANT SHINE WAY",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335585735",
            "telephone_number": "251-458-4334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YELISETTY",
        "first_name": "IRYNA",
        "middle_name": "KORNIYENKO",
        "name_prefix": "Dr.",
        "credential": "D.M.D, M.S.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-13",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "FL",
            "license": "DN28893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lutz, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.