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General NPI Number Information
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NPI Number | 1023224854
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Entity Type | Individual
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Provider Name | JEREMY KENT SELLEY DO
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Gender | Male
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 12/10/2018
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Provider Practice Location Address
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Address Line | 4200 SUN N LAKE BLVD
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City | SEBRING
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State | FL
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Zip | 33872-1986
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Country | US
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Telephone | 863-402-3133
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Fax | 863-402-3135
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Provider Business Mailing Address
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Address Line | 4535 DRESSLER RD NW
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City | CANTON
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State | OH
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Zip | 44718-2545
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Country | US
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Telephone | 330-492-4559
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Fax | 330-409-8274
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2010-00250
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License Number State | NC
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