Healthcare Provider Details

I. General information

NPI: 1154309946
Provider Name (Legal Business Name): DONNA-LEE G SELLAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 04/23/2021
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 HARRISON AVE
BOSTON MA
02118-2905
US

IV. Provider business mailing address

801 ALBANY ST FL G
BOSTON MA
02119-3791
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-6610
  • Fax: 617-638-6616
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number76958
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number76958
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: