Provider Demographics
NPI:1750865630
Name:SELLECHIO, ASHLEY CARMEN (PA-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CARMEN
Last Name:SELLECHIO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:CARMEN
Other - Last Name:HEINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:450 MANCHESTER LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-4542
Mailing Address - Country:US
Mailing Address - Phone:317-506-1175
Mailing Address - Fax:
Practice Address - Street 1:4101 JAMES CASEY ST STE 330
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1145
Practice Address - Country:US
Practice Address - Phone:512-816-8041
Practice Address - Fax:512-804-2360
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA14318363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant