Provider Demographics
NPI:1851811749
Name:NISSIRIOS, ELPIDA HOPE MICHAEL (PSYD)
Entity Type:Individual
Prefix:
First Name:ELPIDA HOPE
Middle Name:MICHAEL
Last Name:NISSIRIOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 ROYAL MILE BLVD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-2321
Mailing Address - Country:US
Mailing Address - Phone:201-873-2697
Mailing Address - Fax:
Practice Address - Street 1:4416 E WEST HWY STE 201
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4572
Practice Address - Country:US
Practice Address - Phone:888-665-8863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0001178103G00000X
VA0810006435103G00000X
MD06351103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty