Provider Demographics
NPI:1265836209
Name:SELBY, SHAMIYRA
Entity Type:Individual
Prefix:
First Name:SHAMIYRA
Middle Name:
Last Name:SELBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 WOODLANE ROAD
Mailing Address - Street 2:
Mailing Address - City:MT.HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060
Mailing Address - Country:US
Mailing Address - Phone:609-267-5928
Mailing Address - Fax:
Practice Address - Street 1:770 WOODLANE ROAD
Practice Address - Street 2:
Practice Address - City:MT.HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060
Practice Address - Country:US
Practice Address - Phone:609-267-5928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJS23567037351832101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health