Provider Demographics
NPI:1881333268
Name:PERSAUD, ELISSA DEPALINI (MSN, RN, ACCNS-AG)
Entity type:Individual
Prefix:MS
First Name:ELISSA
Middle Name:DEPALINI
Last Name:PERSAUD
Suffix:
Gender:F
Credentials:MSN, RN, ACCNS-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BELWYCK BLVD APT 1204
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2909
Mailing Address - Country:US
Mailing Address - Phone:734-612-5907
Mailing Address - Fax:
Practice Address - Street 1:1000 BELWYCK BLVD APT 1204
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2909
Practice Address - Country:US
Practice Address - Phone:734-612-5907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACNS000348364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist