Provider Information for 1164123881
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SHAE SELLERS
Sex: Female
NPI: 1164123881
Last Updated: 2023-03-10
Certification Date: 2023-03-10
Certification Date: 2023-03-10
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1164123881 | ||||||||
| Enumeration Date | 2023-03-10 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 8550 TOUCHTON RD APT 1328 JACKSONVILLE, FL 32216-2213 United States Phone: 630-229-3772 | Fax: | ||||||||
| Primary Practice Address | 8550 TOUCHTON RD APT 1328 JACKSONVILLE, FL 32216-2213 United States Phone: 630-229-3772 | Fax: | ||||||||
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