Provider Demographics
NPI:1093910499
Name:SELEM, LISSETTE (PHYSICIAN/MD)
Entity Type:Individual
Prefix:DR
First Name:LISSETTE
Middle Name:
Last Name:SELEM
Suffix:
Gender:F
Credentials:PHYSICIAN/MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5803 NW 151 ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2473
Mailing Address - Country:US
Mailing Address - Phone:305-696-8802
Mailing Address - Fax:305-696-8156
Practice Address - Street 1:5803 NW 151 ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2473
Practice Address - Country:US
Practice Address - Phone:305-696-8802
Practice Address - Fax:305-696-8156
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR147642084P0800X
FLME1286502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry