Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Angela Manjgaladze

Individual provider Nurse Practitioner · NPI 1194281444

Angela Manjgaladze is a Nurse Practitioner in Victor, New York. Qualified in 2019, 7 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in New York.

Years since qualifying
7
Licensed in
NY
In the registry since
2019
Specialties on file
2

Practice location Address checks out

600 Fishers Station Dr Ste 117
Victor, NY 14564-9784
Phone: (585) 337-0992
Fax: (585) 337-0998
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 402705 (NY)
Nurse Practitioner Taxonomy 363L00000X · Licence 001782 (NY)

Record details

NPI number1194281444
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedFebruary 12, 2019
Last updated in NPPESFebruary 1, 2023
Certification dateFebruary 4, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Victor