Healthcare Provider Details

I. General information

NPI: 1356440788
Provider Name (Legal Business Name): ELLIOT FIELSTEIN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 WESTVIEW DR
NASHVILLE TN
37212-4123
US

IV. Provider business mailing address

2203 WESTVIEW DR
NASHVILLE TN
37212-4123
US

V. Phone/Fax

Practice location:
  • Phone: 615-385-4635
  • Fax:
Mailing address:
  • Phone: 615-385-4635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberP2082
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: