Provider Demographics
NPI:1639474190
Name:SELLA, SHIRI H (PSYD)
Entity Type:Individual
Prefix:
First Name:SHIRI
Middle Name:H
Last Name:SELLA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8004 LINCOLN DR W
Mailing Address - Street 2:SUITE D
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3213
Mailing Address - Country:US
Mailing Address - Phone:609-682-3115
Mailing Address - Fax:
Practice Address - Street 1:8004 LINCOLN DR W
Practice Address - Street 2:SUITE D
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3213
Practice Address - Country:US
Practice Address - Phone:609-682-3115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4824103T00000X
PAPS016789103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist