Provider Demographics
NPI:1710395702
Name:GVELESIANI, NINO (MS, ANP-BC, GNP-BC)
Entity type:Individual
Prefix:
First Name:NINO
Middle Name:
Last Name:GVELESIANI
Suffix:
Gender:F
Credentials:MS, ANP-BC, GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3802 FORT HAMILTON PARKWAY
Mailing Address - Street 2:APT. #4
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1971
Mailing Address - Country:US
Mailing Address - Phone:718-436-7736
Mailing Address - Fax:
Practice Address - Street 1:3802 FORT HAMILTON PARKWAY
Practice Address - Street 2:APT. #4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-1971
Practice Address - Country:US
Practice Address - Phone:718-436-7736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305936363LA2200X
NYF340839363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology