Healthcare Provider Details

I. General information

NPI: 1164860987
Provider Name (Legal Business Name): FAMILY FIRST PEDIATRICS P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 WILLA SPRINGS DR SUITE 1031
WINTER SPRINGS FL
32708-5246
US

IV. Provider business mailing address

1049 WILLA SPRINGS DR SUITE 1031
WINTER SPRINGS FL
32708-5246
US

V. Phone/Fax

Practice location:
  • Phone: 407-335-4760
  • Fax: 407-388-0104
Mailing address:
  • Phone: 407-335-4760
  • Fax: 407-388-0104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME64462
License Number StateFL

VIII. Authorized Official

Name: CLIFFORD SELSKY
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 407-388-4682