MEDICARE: ELLIE SELEVAN M.S.

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1235504861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLIE SELEVAN M.S.

Provider Business Mailing Address
First Line	:	56 BENNETT AVE APT 5K
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-2136
Country	:	US
Telephone Number	:	201-835-9607
Fax Number	:

Provider Business Practice Location Address
First Line	:	56 BENNETT AVE APT 5K
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-2136
Country	:	US
Telephone Number	:	201-835-9607
Fax Number	:

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

Provider Enumeration Date	:	12/08/2015
Last Update Date	:	12/08/2015

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Directions to “ ELLIE SELEVAN M.S.” Practice Location

Language	Start Address	Practice Location

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