| Blue Sky Mental Health Clinic Llc | |
|
10301 Georgia Ave Ste 203 Silver Spring MD 20902-5020 | |
| (301) 754-3740 | |
| Not Available |
| Full Name | Blue Sky Mental Health Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 10301 Georgia Ave Ste 203, Silver Spring, Maryland |
| Authorized Official Name and Position | Jason Gadner Eliassaint (PMHNP-BC) |
| Authorized Official Contact | 4049921632 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Sky Mental Health Clinic Llc 10301 Georgia Ave Ste 203 Silver Spring MD 20902-5020 Ph: (404) 992-1632 | Blue Sky Mental Health Clinic Llc 10301 Georgia Ave Ste 203 Silver Spring MD 20902-5020 Ph: (301) 754-3740 |
| NPI Number | 1184204745 |
|---|---|
| Provider Enumeration Date | 04/08/2021 |
| Last Update Date | 05/14/2021 |
| Certification Date | 04/09/2021 |
| Medicare PECOS PAC ID | 5092124560 |
|---|---|
| Medicare Enrollment ID | O20210805002212 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184204745 | NPI | - | NPPES |
| Provider Name | Jason Gadner Eliassaint |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972143915 PECOS PAC ID: 6901215474 Enrollment ID: I20210805002284 |
| Provider Name | Carlson Nchiazeh Nkemnkeng |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770848871 PECOS PAC ID: 0941654602 Enrollment ID: I20230928002482 |
| Provider Name | Constantine Lewko |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922470905 PECOS PAC ID: 7517203102 Enrollment ID: I20230929002919 |
| Provider Name | Adewole Alabi Ogundepo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689878753 PECOS PAC ID: 2961858634 Enrollment ID: I20231101001542 |
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