Provider Demographics
NPI:1437196227
Name:SELVARAJAH, AMINTHA M (PA-C)
Entity Type:Individual
Prefix:
First Name:AMINTHA
Middle Name:M
Last Name:SELVARAJAH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMINTHA
Other - Middle Name:M
Other - Last Name:ARASARATNAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:138 NORTH COURT STREET
Mailing Address - Street 2:
Mailing Address - City:WAMPSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13163-0608
Mailing Address - Country:US
Mailing Address - Phone:315-366-2327
Mailing Address - Fax:
Practice Address - Street 1:138 NORTH COURT STREET
Practice Address - Street 2:
Practice Address - City:WAMPSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13163-0608
Practice Address - Country:US
Practice Address - Phone:315-366-2327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052340363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant