Healthcare Provider Details

I. General information

NPI: 1720294556
Provider Name (Legal Business Name): VICTORIA HUTTO SELLEY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA ELIZABETH HUTTO DO

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 SUN N LAKE BLVD
SEBRING FL
33872-1986
US

IV. Provider business mailing address

4535 DRESSLER RD NW
CANTON OH
44718-2545
US

V. Phone/Fax

Practice location:
  • Phone: 863-402-3133
  • Fax: 863-402-3135
Mailing address:
  • Phone: 330-492-4559
  • Fax: 330-409-8274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOT011609
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2010-00530
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: