Healthcare Provider Details

I. General information

NPI: 1457812737
Provider Name (Legal Business Name): SUZANNA ELIZABETH SELLARS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

6800 N ELM TREE RD
MILWAUKEE WI
53217-3702
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-3537
  • Fax:
Mailing address:
  • Phone: 414-412-3640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberOT019645
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS023405
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: