Provider Demographics
NPI:1174216675
Name:SELLERS, WANDA G
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:G
Last Name:SELLERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 11TH ST NW APT 814
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-2251
Mailing Address - Country:US
Mailing Address - Phone:301-742-5951
Mailing Address - Fax:
Practice Address - Street 1:2301 11TH ST NW APT 814
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-2251
Practice Address - Country:US
Practice Address - Phone:120-252-5395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator