Provider Demographics
NPI:1841604162
Name:SELBY, CLORETTA
Entity Type:Individual
Prefix:
First Name:CLORETTA
Middle Name:
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 1:31033 OMAR RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19945-2810
Mailing Address - Country:US
Mailing Address - Phone:302-233-2409
Mailing Address - Fax:
Practice Address - Street 1:31033 OMAR RD
Practice Address - Street 2:
Practice Address - City:FRANKFORD
Practice Address - State:DE
Practice Address - Zip Code:19945-2810
Practice Address - Country:US
Practice Address - Phone:302-233-2409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker