Provider Demographics
NPI:1942780465
Name:SELDEN, SHAY (PSYD, MED)
Entity type:Individual
Prefix:DR
First Name:SHAY
Middle Name:
Last Name:SELDEN
Suffix:
Gender:F
Credentials:PSYD, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S BROAD ST STE 834
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19110-1018
Mailing Address - Country:US
Mailing Address - Phone:267-209-3390
Mailing Address - Fax:267-930-6250
Practice Address - Street 1:100 S BROAD ST STE 834
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19110-1018
Practice Address - Country:US
Practice Address - Phone:267-209-3390
Practice Address - Fax:267-930-6250
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018572103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical