Healthcare Provider Details

I. General information

NPI: 1336906833
Provider Name (Legal Business Name): MICHAEL DESHAWN SELLS CASAC-T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E 15TH ST FL 7
NEW YORK NY
10003-3153
US

IV. Provider business mailing address

9730 57TH AVE APT 2H
CORONA NY
11368-3501
US

V. Phone/Fax

Practice location:
  • Phone: 212-627-9600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number42509
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: