Provider Demographics
NPI:1093189995
Name:KAKHELADZE, TAMARA G (TAMARA KAKHELADZE)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:G
Last Name:KAKHELADZE
Suffix:
Gender:F
Credentials:TAMARA KAKHELADZE
Other - Prefix:MS
Other - First Name:TAMARA
Other - Middle Name:G
Other - Last Name:KAKHELADZE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:TAMARA KAKHELADZE
Mailing Address - Street 1:2000 OCEAN AVE
Mailing Address - Street 2:A4
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7356
Mailing Address - Country:US
Mailing Address - Phone:718-844-8257
Mailing Address - Fax:
Practice Address - Street 1:2000 OCEAN AVE
Practice Address - Street 2:A4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7356
Practice Address - Country:US
Practice Address - Phone:718-844-8257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist