Healthcare Provider Details

I. General information

NPI: 1962685743
Provider Name (Legal Business Name): MICHELE L SELSOR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7744 66TH ST N
PINELLAS PARK FL
33781-3100
US

IV. Provider business mailing address

5851 93RD AVE N
PINELLAS PARK FL
33782-4905
US

V. Phone/Fax

Practice location:
  • Phone: 727-321-9488
  • Fax: 727-321-2033
Mailing address:
  • Phone: 727-321-9488
  • Fax: 727-321-2033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO2916
License Number StateFL

VIII. Authorized Official

Name: MICHELE L SELSOR
Title or Position: PRESIDENT
Credential: DPM
Phone: 727-321-9488