Basic Information
| Provider Information | |||||||||
| NPI: | 1881884138 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SELLA | ||||||||
| FirstName: | SHELLEY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5301 F ST | ||||||||
| Address2: | STE 10 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958193226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882700340 | ||||||||
| FaxNumber: | 8882700331 | ||||||||
| Practice Location | |||||||||
| Address1: | 5301 F ST | ||||||||
| Address2: | STE 10 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958193226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882700340 | ||||||||
| FaxNumber: | 8882700331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2007 | ||||||||
| LastUpdateDate: | 08/01/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | A45595 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 04-29603 | 01 | KS | MD LICENSE | OTHER |