Provider Demographics
NPI:1093766602
Name:SELSKY, CLIFFORD ALLEN
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:ALLEN
Last Name:SELSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 CASA ALOMA WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2272
Mailing Address - Country:US
Mailing Address - Phone:407-335-4760
Mailing Address - Fax:877-695-8583
Practice Address - Street 1:2830 CASA ALOMA WAY
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2272
Practice Address - Country:US
Practice Address - Phone:407-335-4760
Practice Address - Fax:877-695-8583
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME644622080P0207X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68655OtherBCBS
8300002206OtherRAILROAD MEDICARE
FL373520600Medicaid
E89927Medicare UPIN
FL373520600Medicaid