Provider Demographics
NPI:1578502225
Name:SELLERS, DEBORAH MARTIN (FNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MARTIN
Last Name:SELLERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 FULTON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-3651
Mailing Address - Country:US
Mailing Address - Phone:516-385-2920
Mailing Address - Fax:516-385-2293
Practice Address - Street 1:72 FULTON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3651
Practice Address - Country:US
Practice Address - Phone:516-385-2920
Practice Address - Fax:516-385-2293
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333895-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02739480Medicaid
NY035XJ1Medicare PIN
NYQ76357Medicare UPIN