Provider Demographics
NPI:1326807827
Name:POLGARDY, SELENA ELIZABETH
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:ELIZABETH
Last Name:POLGARDY
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 1:117 MEGAN ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2167
Mailing Address - Country:US
Mailing Address - Phone:818-209-0098
Mailing Address - Fax:
Practice Address - Street 1:1261 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3639
Practice Address - Country:US
Practice Address - Phone:818-209-0098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty