Healthcare Provider Details

I. General information

NPI: 1891255410
Provider Name (Legal Business Name): JENNA MARIE SELANDER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 ELECTRIC RD
ROANOKE VA
24018-1601
US

IV. Provider business mailing address

4415 REEDY FORK PKWY
GREENSBORO NC
27405-8269
US

V. Phone/Fax

Practice location:
  • Phone: 540-772-7171
  • Fax:
Mailing address:
  • Phone: 207-227-7202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0102207950
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: