Healthcare Provider Details

I. General information

NPI: 1770997017
Provider Name (Legal Business Name): MONICA SELANDER-HAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2014
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 BLACK RIVER RD STE 300
GEORGETOWN SC
29440-3304
US

IV. Provider business mailing address

PO BOX 421718
GEORGETOWN SC
29442-4203
US

V. Phone/Fax

Practice location:
  • Phone: 843-527-4343
  • Fax:
Mailing address:
  • Phone: 843-527-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101021341
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: