Provider Demographics
NPI:1831988328
Name:COBB, SELENA BRIDGET
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:BRIDGET
Last Name:COBB
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:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NY
Mailing Address - Zip Code:14411-0517
Mailing Address - Country:US
Mailing Address - Phone:916-891-7768
Mailing Address - Fax:585-831-5671
Practice Address - Street 1:23 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-1020
Practice Address - Country:US
Practice Address - Phone:916-891-7768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11868133V00000X
NY011267-01133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered