Provider Demographics
NPI:1902503600
Name:SELLERS, JESSICA MARIE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
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 1:2891 E. MAPLE RD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083
Mailing Address - Country:US
Mailing Address - Phone:248-726-0127
Mailing Address - Fax:
Practice Address - Street 1:21675 COOLIDGE HWY.
Practice Address - Street 2:SUITE A
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237
Practice Address - Country:US
Practice Address - Phone:248-914-3211
Practice Address - Fax:248-918-4958
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program