Provider Demographics
NPI:1235464579
Name:SELLS, DAVID J
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:SELLS
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 1:15 SHEPARD RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2428
Mailing Address - Country:US
Mailing Address - Phone:203-988-7302
Mailing Address - Fax:
Practice Address - Street 1:88 NOBLE AVE
Practice Address - Street 2:STE 201
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4738
Practice Address - Country:US
Practice Address - Phone:203-988-7302
Practice Address - Fax:203-877-1404
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002964103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical