Provider Demographics
NPI:1386690931
Name:SELLAS, MONIQUE I (MD)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:I
Last Name:SELLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 GARDENDALE ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3132
Mailing Address - Country:US
Mailing Address - Phone:210-614-0180
Mailing Address - Fax:
Practice Address - Street 1:4204 GARDENDALE ST
Practice Address - Street 2:SUITE 312
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3132
Practice Address - Country:US
Practice Address - Phone:210-614-0180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227823207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110073526/AMedicaid
MA110073526/AMedicaid
MAA39995Medicare PIN