Healthcare Provider Details

I. General information

NPI: 1235687690
Provider Name (Legal Business Name): MICHAEL SELEPEC PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 GLADES RD STE 100
BOCA RATON FL
33431-6462
US

IV. Provider business mailing address

670 GLADES RD STE 100
BOCA RATON FL
33431-6462
US

V. Phone/Fax

Practice location:
  • Phone: 561-955-3500
  • Fax: 561-955-2690
Mailing address:
  • Phone: 561-955-3500
  • Fax: 561-955-2690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9109779
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9109779
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: