Provider Demographics
NPI:1679370910
Name:MACHAIDZE, SOFIA (LVN)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:MACHAIDZE
Suffix:
Gender:
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8209 BURLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-7315
Mailing Address - Country:US
Mailing Address - Phone:469-818-0864
Mailing Address - Fax:
Practice Address - Street 1:8209 BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-7315
Practice Address - Country:US
Practice Address - Phone:469-818-0864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1107413164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse