Provider Demographics
NPI:1942346242
Name:SELLERS, AUDREY DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:DENISE
Last Name:SELLERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 MARKET ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-1513
Mailing Address - Country:US
Mailing Address - Phone:415-863-3883
Mailing Address - Fax:415-863-7343
Practice Address - Street 1:1111 MARKET ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-1513
Practice Address - Country:US
Practice Address - Phone:415-863-3883
Practice Address - Fax:415-863-7343
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62874208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D869143OtherCLIA WAIVER
CAOOG628740OtherMEDI-CAL
CAOOG628740OtherMEDI-CAL
CAOOG628740OtherMEDI-CAL
CAOOG628741Medicare UPIN
CABS1453959OtherDEA NUMBER