Healthcare Provider Details

I. General information

NPI: 1093766602
Provider Name (Legal Business Name): CLIFFORD ALLEN SELSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 CASA ALOMA WAY
WINTER PARK FL
32792-2272
US

IV. Provider business mailing address

2830 CASA ALOMA WAY
WINTER PARK FL
32792-2272
US

V. Phone/Fax

Practice location:
  • Phone: 407-335-4760
  • Fax: 877-695-8583
Mailing address:
  • Phone: 407-335-4760
  • Fax: 877-695-8583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME64462
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberME64462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: