Provider Demographics
NPI:1184905515
Name:SELIBY, LATASHA RASHONDA (MD)
Entity type:Individual
Prefix:DR
First Name:LATASHA
Middle Name:RASHONDA
Last Name:SELIBY
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 1:853 N CHURCH ST
Mailing Address - Street 2:510
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3098
Mailing Address - Country:US
Mailing Address - Phone:864-506-1558
Mailing Address - Fax:
Practice Address - Street 1:853 N CHURCH ST
Practice Address - Street 2:SUITE 510
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3098
Practice Address - Country:US
Practice Address - Phone:864-560-1558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL33979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine