| Eleanor Health Professional Tx, Pllc | |
|
8500 Village Dr Ste 101 San Antonio TX 78217-5510 | |
| (726) 201-3047 | |
| (833) 629-0318 |
| Full Name | Eleanor Health Professional Tx, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 8500 Village Dr Ste 101, San Antonio, Texas |
| Authorized Official Name and Position | Sade Renee Keith (LEAD CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 9193668743 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eleanor Health Professional Tx, Pllc 221 Crescent St Ste 202 Waltham MA 02453-3425 Ph: (919) 366-8743 | Eleanor Health Professional Tx, Pllc 8500 Village Dr Ste 101 San Antonio TX 78217-5510 Ph: (726) 201-3047 |
| NPI Number | 1932854981 |
|---|---|
| Provider Enumeration Date | 02/18/2022 |
| Last Update Date | 02/07/2023 |
| Certification Date | 02/07/2023 |
| Medicare PECOS PAC ID | 9335527118 |
|---|---|
| Medicare Enrollment ID | O20220607002036 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932854981 | NPI | - | NPPES |
| Provider Name | Ellen M Sundstrom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962688788 PECOS PAC ID: 8022189430 Enrollment ID: I20080612000344 |
| Provider Name | Saleha Jafar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477638302 PECOS PAC ID: 0648412304 Enrollment ID: I20200317002142 |
| Provider Name | Crystal Ann Randolph |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811463797 PECOS PAC ID: 3072924463 Enrollment ID: I20201116000220 |
| Provider Name | Cynthia R Scott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134799901 PECOS PAC ID: 6507268331 Enrollment ID: I20210715002074 |
| Provider Name | Christina Vasquez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649933516 PECOS PAC ID: 4880026632 Enrollment ID: I20211026001014 |
| Provider Name | Nzinga Ajabu Harrison |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518099910 PECOS PAC ID: 5698793875 Enrollment ID: I20220607002118 |
| Provider Name | Jessica D Pereira |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063931095 PECOS PAC ID: 0547650525 Enrollment ID: I20220628000070 |
| Provider Name | Bret Damon Kirson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861700676 PECOS PAC ID: 8921341280 Enrollment ID: I20220629000908 |
| Provider Name | Stephen William North |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073611091 PECOS PAC ID: 3476527300 Enrollment ID: I20221006003260 |
| Provider Name | Mark Mcgrail |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1063488831 PECOS PAC ID: 9931336476 Enrollment ID: I20221107001773 |
| Provider Name | Manisha Vijay Shroff |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699708750 PECOS PAC ID: 9234134404 Enrollment ID: I20221220001484 |
| Provider Name | Alessia Bhargava |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881129013 PECOS PAC ID: 9739450081 Enrollment ID: I20230524001135 |
| Provider Name | Lachaya Mary Radcliff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467918029 PECOS PAC ID: 0345675062 Enrollment ID: I20230818000208 |
| Provider Name | Brad Allen Olson |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1225032147 PECOS PAC ID: 6002243615 Enrollment ID: I20230831003121 |
| Provider Name | Andrew William Runkle |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1134211881 PECOS PAC ID: 2769468271 Enrollment ID: I20240514002163 |
| Provider Name | Rewa Banks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134595416 PECOS PAC ID: 2264729953 Enrollment ID: I20240531000609 |
| Provider Name | Kathryne Volpe-bates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255872974 PECOS PAC ID: 6507131950 Enrollment ID: I20240612001386 |
| Provider Name | Monique Pierre Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588184220 PECOS PAC ID: 6507130341 Enrollment ID: I20240725004554 |
| Provider Name | Virmarie Diaz Fernandez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306248075 PECOS PAC ID: 8628499506 Enrollment ID: I20240730002686 |
| Provider Name | Scherrica Holli Henderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043987431 PECOS PAC ID: 4981142569 Enrollment ID: I20240814000757 |
| Provider Name | Alexia Davida Montague |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962929679 PECOS PAC ID: 6800236530 Enrollment ID: I20240814004053 |
| Provider Name | Brianne Faye Collins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225768724 PECOS PAC ID: 7517330970 Enrollment ID: I20240815004016 |
| Provider Name | Colleen Hannush |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669648515 PECOS PAC ID: 2163561069 Enrollment ID: I20240819004396 |
| Provider Name | Jalessa Shanice Cherry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013447960 PECOS PAC ID: 3870909419 Enrollment ID: I20240930002603 |
| Provider Name | Ashley Campbell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437644796 PECOS PAC ID: 0749528347 Enrollment ID: I20241018003713 |
| Provider Name | Amanda Culp Roche |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558592709 PECOS PAC ID: 5496801052 Enrollment ID: I20241209000418 |
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