Provider Demographics
NPI:1326018177
Name:SELOS-HOY, ELAINE VICTORIA (PA-C)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:VICTORIA
Last Name:SELOS-HOY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 COOPER FOSTER PARK ROAD LN20
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053
Mailing Address - Country:US
Mailing Address - Phone:440-204-7439
Mailing Address - Fax:440-988-5652
Practice Address - Street 1:5700 COOPER FOSTER PARK RD W
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-4152
Practice Address - Country:US
Practice Address - Phone:440-204-7439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-001953363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000331783OtherANTHEM
OH000000331783OtherANTHEM
OHPA77361Medicare ID - Type Unspecified