Healthcare Provider Details

I. General information

NPI: 1336906833
Provider Name (Legal Business Name): MICHAEL DESHAWN SELLS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2631 MERRICK RD
BELLMORE NY
11710-5730
US

IV. Provider business mailing address

210 W 262ND ST APT 1L
BRONX NY
10471-1149
US

V. Phone/Fax

Practice location:
  • Phone: 516-590-7575
  • Fax:
Mailing address:
  • Phone: 302-359-0931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: