Healthcare Provider Details

I. General information

NPI: 1306595467
Provider Name (Legal Business Name): GENEVIEVE ALLYNE SELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 MEDICAL DR STE 102
CARMEL IN
46032-3078
US

IV. Provider business mailing address

8414 NAAB RD STE 200
INDIANAPOLIS IN
46260-1972
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-5960
  • Fax:
Mailing address:
  • Phone: 317-338-7510
  • Fax: 317-338-7540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number02007543A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: