Provider Demographics
NPI:1487630125
Name:SELLERS, TRAVELLA A (DPM)
Entity Type:Individual
Prefix:
First Name:TRAVELLA
Middle Name:A
Last Name:SELLERS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14759
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27620-4759
Mailing Address - Country:US
Mailing Address - Phone:919-231-7969
Mailing Address - Fax:919-231-7970
Practice Address - Street 1:740 SUTTERS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804
Practice Address - Country:US
Practice Address - Phone:252-451-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC456213ES0103X
VA0103301233213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890807TMedicaid
NC0807TOtherBCBS
NC2433640AMedicare ID - Type UnspecifiedMEDICARE
NC890807TMedicaid