Healthcare Provider Details

I. General information

NPI: 1528597002
Provider Name (Legal Business Name): SELINA JUAREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MEDICAL PKWY STE 200
GREER SC
29650-2441
US

IV. Provider business mailing address

300 E MCBEE AVE STE 300
GREENVILLE SC
29601-2899
US

V. Phone/Fax

Practice location:
  • Phone: 864-797-9400
  • Fax: 864-797-9402
Mailing address:
  • Phone: 864-522-8611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD484296
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD484296
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number91169
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier16212644
Identifier TypeOTHER
Identifier State
Identifier IssuerCAQH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: