Provider Demographics
NPI:1235793852
Name:SELDES, ALYSSA (PA)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:SELDES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5296 TURTLE CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-7643
Mailing Address - Country:US
Mailing Address - Phone:585-764-3679
Mailing Address - Fax:
Practice Address - Street 1:10050 SW INNOVATION WAY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2117
Practice Address - Country:US
Practice Address - Phone:772-344-3811
Practice Address - Fax:772-335-2422
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024116363A00000X
FL9116212363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant