Provider Demographics
NPI:1811929920
Name:SINNA, SELVARATNAM (MD)
Entity type:Individual
Prefix:
First Name:SELVARATNAM
Middle Name:
Last Name:SINNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 CAPE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2139
Mailing Address - Country:US
Mailing Address - Phone:910-483-0049
Mailing Address - Fax:910-339-8905
Practice Address - Street 1:3650 CAPE CENTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2139
Practice Address - Country:US
Practice Address - Phone:910-483-0049
Practice Address - Fax:910-339-8905
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234558207RC0000X
NC200801024207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02374165Medicaid
NYH65135Medicare UPIN
NYSS0064AE10Medicare ID - Type Unspecified