Healthcare Provider Details

I. General information

NPI: 1942413422
Provider Name (Legal Business Name): JANELLE SELVA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 ELM DR.
WAYNESBURG PA
15370-8269
US

IV. Provider business mailing address

7 GLASSWORKS RD
GREENSBORO PA
15338-9507
US

V. Phone/Fax

Practice location:
  • Phone: 724-627-0926
  • Fax: 724-627-0812
Mailing address:
  • Phone: 724-943-3308
  • Fax: 724-943-4929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA050627
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: