Provider Demographics
NPI:1437595667
Name:TURABELIDZE, KRISTINA
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:TURABELIDZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 AVENUE Y
Mailing Address - Street 2:APT 8E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1452
Mailing Address - Country:US
Mailing Address - Phone:347-527-6837
Mailing Address - Fax:
Practice Address - Street 1:3020 AVENUE Y
Practice Address - Street 2:APT 8E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1452
Practice Address - Country:US
Practice Address - Phone:347-527-6837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024134235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist