MEDICARE: SELWYN G. DANIEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	103165	NC

General Provider Information

NPI Number	:	1063437135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELWYN G. DANIEL

Provider Business Mailing Address
First Line	:	3068 SUNSET AVE
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-3647
Country	:	US
Telephone Number	:	252-316-8103
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 SOUTHTOWN CIR
Second Line	:
City	:	ROLESVILLE
State	:	NC
Zip	:	27571-9591
Country	:	US
Telephone Number	:	919-570-3266
Fax Number	:	919-217-3084

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	06/10/2016

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