Healthcare Provider Details

I. General information

NPI: 1659234649
Provider Name (Legal Business Name): GALYA KAMENOVA RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 CENTRE ST
JAMAICA PLAIN MA
02130-2555
US

IV. Provider business mailing address

640 CENTRE ST
JAMAICA PLAIN MA
02130-2555
US

V. Phone/Fax

Practice location:
  • Phone: 617-983-4103
  • Fax:
Mailing address:
  • Phone: 617-983-4103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN2325597
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: