Provider Demographics
NPI:1679241053
Name:BOYD, SELENA
Entity Type:Individual
Prefix:MRS
First Name:SELENA
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MERIDIAN ST N STE 39
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4616
Mailing Address - Country:US
Mailing Address - Phone:256-945-3006
Mailing Address - Fax:
Practice Address - Street 1:1300 MERIDIAN ST N STE 39
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4616
Practice Address - Country:US
Practice Address - Phone:256-945-3006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor