Provider Demographics
NPI:1255765293
Name:ZELSDORF, ERIC (PSYD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:ZELSDORF
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 S KING ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-2905
Mailing Address - Country:US
Mailing Address - Phone:703-464-7400
Mailing Address - Fax:703-777-0170
Practice Address - Street 1:217 S KING ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-2905
Practice Address - Country:US
Practice Address - Phone:703-464-7400
Practice Address - Fax:703-777-0170
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005246103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist