Provider Demographics
NPI:1578002135
Name:ROY, SELINAMMA (NP)
Entity Type:Individual
Prefix:MS
First Name:SELINAMMA
Middle Name:
Last Name:ROY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 N NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-1225
Mailing Address - Country:US
Mailing Address - Phone:818-566-8440
Mailing Address - Fax:818-566-8440
Practice Address - Street 1:1948 N NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-1225
Practice Address - Country:US
Practice Address - Phone:818-566-8440
Practice Address - Fax:818-566-8440
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA676439163W00000X
CANP95005243163W00000X
CA95005243363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology