Healthcare Provider Details

I. General information

NPI: 1104738467
Provider Name (Legal Business Name): MS. KYRMINA DAMIANA GIANCOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12500 REED HARTMAN HWY
CINCINNATI OH
45241-1892
US

IV. Provider business mailing address

5733 TORREY PINES AVE
WESTERVILLE OH
43082-8754
US

V. Phone/Fax

Practice location:
  • Phone: 513-547-2861
  • Fax:
Mailing address:
  • Phone: 614-984-4667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberYPS.000113
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: