Provider Demographics
NPI:1922310655
Name:SELBO-BRUNS, ALEXANDRA
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:SELBO-BRUNS
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 1:1217 E MAIN ST
Mailing Address - Street 2:#2B
Mailing Address - City:SHRUB OAK
Mailing Address - State:NY
Mailing Address - Zip Code:10588-1417
Mailing Address - Country:US
Mailing Address - Phone:914-737-7338
Mailing Address - Fax:914-737-1050
Practice Address - Street 1:1101 MAIN ST
Practice Address - Street 2:C/O WJCS
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2907
Practice Address - Country:US
Practice Address - Phone:914-737-7337
Practice Address - Fax:914-737-1050
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program