Provider Demographics
NPI:1255867180
Name:SELTZER, SALLIE
Entity Type:Individual
Prefix:
First Name:SALLIE
Middle Name:
Last Name:SELTZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RAVEN
Other - Middle Name:SADHAKA
Other - Last Name:SELTZER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:50 GREATON RD
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-1405
Mailing Address - Country:US
Mailing Address - Phone:617-869-9574
Mailing Address - Fax:
Practice Address - Street 1:50 GREATON RD
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-1405
Practice Address - Country:US
Practice Address - Phone:617-869-9574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist