Provider Demographics
NPI:1669203907
Name:SELOGY, NICHOLAS ALAN
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ALAN
Last Name:SELOGY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 7TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44647-7812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1878 RAVENNA AVE SE
Practice Address - Street 2:
Practice Address - City:EAST CANTON
Practice Address - State:OH
Practice Address - Zip Code:44730-9532
Practice Address - Country:US
Practice Address - Phone:330-546-8682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide