Provider Demographics
NPI:1699412536
Name:SELBY, TRISHA MARIE
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:MARIE
Last Name:SELBY
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 1:3791 SLEEPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-4160
Mailing Address - Country:US
Mailing Address - Phone:330-888-8994
Mailing Address - Fax:
Practice Address - Street 1:3791 SLEEPY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-4160
Practice Address - Country:US
Practice Address - Phone:330-888-8994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide