Healthcare Provider Details

I. General information

NPI: 1760307375
Provider Name (Legal Business Name): SELAH ANNA-SALUD BANEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 MARKET ST STE 2
LYNN MA
01901-1148
US

IV. Provider business mailing address

255 GRAPEVINE RD BOX 230
WENHAM MA
01984-1813
US

V. Phone/Fax

Practice location:
  • Phone: 774-504-4066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: