Individual provider Active NPI

Eliana Sudikoff, PHD

  • Clinical Neuropsychologist
  • Washington, DC
National Provider Identifier
1306322466
Registry record updated Oct 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
06129 Issued in MD
Practice address
111 Michigan Ave NW
Washington, DC 20010-2916
Phone
(202) 476-5000
NPI assigned
Jul 12, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 1, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Clinical Neuropsychologist 103G00000X 06129 MD Primary

Addresses

Primary practice location

111 Michigan Ave NW
Washington, DC 20010-2916

Mailing address

PO Box 744785
Atlanta, GA 30374-4785
Phone (202) 476-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20201113000032 DC Practitioner - Clinical Psychologist 0244640662 Reassigns benefits to 1 organization
I20240103002128 MD Practitioner - Clinical Psychologist 0244640662 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Children's Hospital CurrentSince Nov 9, 2020 Accepting new patients
Kennedy Krieger Associates CurrentSince Oct 17, 2023 Accepting new patients
Children's Hospital Current Accepting new patients
Children's Hospital CurrentSince Nov 9, 2020 Accepting new patients
Kennedy Krieger Associates CurrentSince Oct 17, 2023 Accepting new patients

Locations

111 Michigan Ave NW
Washington, DC 20010
Phone (202) 476-3670

707 N Broadway
Baltimore, MD 21205
Phone (443) 923-1870

1741 Ashland Ave
Rm 646
Baltimore, MD 21205
Phone (443) 923-1842

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1531353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601510400000",
    "number": "1306322466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 744785",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303744785",
            "telephone_number": "202-476-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 MICHIGAN AVE NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200102916",
            "telephone_number": "202-476-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUDIKOFF",
        "first_name": "ELIANA",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-12",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MD",
            "license": "06129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.