Provider Demographics
NPI:1740251362
Name:SELLARS, BRUCE (PSYD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:SELLARS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 ELECTRIC RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3547
Mailing Address - Country:US
Mailing Address - Phone:540-772-5153
Mailing Address - Fax:540-772-5157
Practice Address - Street 1:2727 ELECTRIC RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3547
Practice Address - Country:US
Practice Address - Phone:540-772-5153
Practice Address - Fax:540-772-5157
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001401103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
R65815Medicare UPIN
VA00W768L94Medicare ID - Type UnspecifiedRICHMOND MEDICARE