MEDICARE: NINA KISHOVA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1518819093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINA KISHOVA

Provider Business Mailing Address
First Line	:	6705 VAN BUREN RD
Second Line	:
City	:	WARNERS
State	:	NY
Zip	:	13164-9776
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	803 ALLEN RD
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-1999
Country	:	US
Telephone Number	:	315-218-2300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “ NINA KISHOVA ” Practice Location

Language	Start Address	Practice Location

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