Healthcare Provider Details

I. General information

NPI: 1104402452
Provider Name (Legal Business Name): IRYNA ZHUKOUSKAYA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CAMBRIDGE ST FL 2
BRIGHTON MA
02135-2907
US

IV. Provider business mailing address

960 MASSACHUSETTS AVE STE 2
BOSTON MA
02118-2690
US

V. Phone/Fax

Practice location:
  • Phone: 161-778-9242
  • Fax:
Mailing address:
  • Phone: 617-414-4505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNP2268299
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: