Nick Velissaris, M.S., PH.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

6301017914 Issued in MI

Practice address

2502 Packard St Unit 3210
Ann Arbor, MI 48104-6850

Phone

(847) 778-3383

NPI assigned

Dec 13, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science, Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607817600000",
    "number": "1053907188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2502 PACKARD ST UNIT 3210",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481046850",
            "telephone_number": "847-778-3383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2502 PACKARD ST UNIT 3210",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481046850",
            "telephone_number": "847-778-3383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VELISSARIS",
        "first_name": "NICK",
        "name_prefix": "Dr.",
        "credential": "M.S., PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-12-13",
        "last_updated": "2020-12-13",
        "certification_date": "2020-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "MI",
            "license": "6301017914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Neuropsychologist in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Clinical Neuropsychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.