Provider Demographics
NPI:1922985126
Name:GERONDAKIS, HEIDI (CRNP)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:GERONDAKIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12212 SNOWDEN WOODS RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2496
Mailing Address - Country:US
Mailing Address - Phone:443-609-2278
Mailing Address - Fax:
Practice Address - Street 1:13334 CLARKSVILLE PIKE BLDG C, SUITE B
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MD
Practice Address - Zip Code:20777
Practice Address - Country:US
Practice Address - Phone:301-618-0829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR228144363LP0808X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice