Provider Demographics
NPI:1639538143
Name:SELWACH, AMY JOY (DO, MBA)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:JOY
Last Name:SELWACH
Suffix:
Gender:F
Credentials:DO, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 N COCOA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-7008
Mailing Address - Country:US
Mailing Address - Phone:321-866-8847
Mailing Address - Fax:954-351-8349
Practice Address - Street 1:870 N COCOA BLVD STE A
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7588
Practice Address - Country:US
Practice Address - Phone:321-866-8847
Practice Address - Fax:954-351-8349
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2021-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14936202C00000X, 207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine