Provider Demographics
NPI:1275547523
Name:SELLERS, ALICE FAYE (LMT)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:FAYE
Last Name:SELLERS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:DALLAS
Other - Middle Name:
Other - Last Name:SELLERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2991 TUSCARORA TRL
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-8226
Mailing Address - Country:US
Mailing Address - Phone:904-563-1444
Mailing Address - Fax:
Practice Address - Street 1:2991 TUSCARORA TRL
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-8226
Practice Address - Country:US
Practice Address - Phone:904-563-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA31130174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist