MEDICARE: MESAY GEBRESILASSIE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R196623	MD
2	363LF0000X	Family Nurse Practitioner	R196623	MD

General Provider Information

NPI Number	:	1568918472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MESAY GEBRESILASSIE NP

Provider Business Mailing Address
First Line	:	3132 CASTLELEIGH RD
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-1713
Country	:	US
Telephone Number	:	240-991-2197
Fax Number	:

Provider Business Practice Location Address
First Line	:	11120 NEW HAMPSHIRE AVE
Second Line	:	SUITE 309
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-2633
Country	:	US
Telephone Number	:	240-991-2197
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	04/13/2026

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