Healthcare Provider Details

I. General information

NPI: 1942780465
Provider Name (Legal Business Name): SHAY SELDEN PSYD, MED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S BROAD ST STE 834
PHILADELPHIA PA
19110-1018
US

IV. Provider business mailing address

100 S BROAD ST STE 834
PHILADELPHIA PA
19110-1018
US

V. Phone/Fax

Practice location:
  • Phone: 267-209-3390
  • Fax: 267-930-6250
Mailing address:
  • Phone: 267-209-3390
  • Fax: 267-930-6250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS018572
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: