Healthcare Provider Details

I. General information

NPI: 1245169184
Provider Name (Legal Business Name): NIMEL TMS & SPRAVATO CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 LITTLESTOWN PIKE STE E
WESTMINSTER MD
21157-3007
US

IV. Provider business mailing address

10801 GREEN ASH LN
BELTSVILLE MD
20705-3851
US

V. Phone/Fax

Practice location:
  • Phone: 301-272-1074
  • Fax:
Mailing address:
  • Phone: 301-263-4890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDRA LAKE
Title or Position: MEDICAL DIRECTOR
Credential: LAKE
Phone: 301-263-4890