MEDICARE: LINDA NISANOVA

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1063239903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA NISANOVA

Provider Business Mailing Address
First Line	:	4901 SEMINARY RD APT 1403
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22311-1830
Country	:	US
Telephone Number	:	917-536-3475
Fax Number	:

Provider Business Practice Location Address
First Line	:	166 DEFENSE HWY
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-8919
Country	:	US
Telephone Number	:	410-684-3806
Fax Number	:

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

Provider Enumeration Date	:	09/23/2024
Last Update Date	:	09/23/2024

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Directions to “ LINDA NISANOVA ” Practice Location

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