Provider Demographics
NPI:1770963399
Name:SELEM, SARAH MARIE (MD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIE
Last Name:SELEM
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 1:6920 NERVIA ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-3615
Mailing Address - Country:US
Mailing Address - Phone:305-667-0940
Mailing Address - Fax:305-667-0938
Practice Address - Street 1:6920 NERVIA ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3615
Practice Address - Country:US
Practice Address - Phone:305-667-0940
Practice Address - Fax:305-667-0938
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2018-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN# 21594390200000X
FLME134919208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program