Healthcare Provider Details

I. General information

NPI: 1558274993
Provider Name (Legal Business Name): NINO IASESHVILI KIGURADZE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 BAY 13TH ST APT 3
BROOKLYN NY
11214-6209
US

IV. Provider business mailing address

162 BAY 13TH ST APT 3
BROOKLYN NY
11214-6209
US

V. Phone/Fax

Practice location:
  • Phone: 929-509-8316
  • Fax:
Mailing address:
  • Phone: 929-509-8316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: