Provider Demographics
NPI:1699383786
Name:SELLERS, MADISON
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:SELLERS
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 1:9908 QUIET GLEN CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2563
Mailing Address - Country:US
Mailing Address - Phone:202-710-9253
Mailing Address - Fax:
Practice Address - Street 1:1 EMBARCADERO CTR STE 1900
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-3723
Practice Address - Country:US
Practice Address - Phone:415-814-0927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC174H00000X
MA174H00000X
VA174H00000X
GA174H00000X
NY174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator