Provider Demographics
NPI:1861905127
Name:SELIKOFF, NANCY B (MA, MED, CRC)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:B
Last Name:SELIKOFF
Suffix:
Gender:F
Credentials:MA, MED, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 ECHO HILL DR
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903-1017
Mailing Address - Country:US
Mailing Address - Phone:203-247-4500
Mailing Address - Fax:
Practice Address - Street 1:177 POST RD W
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4652
Practice Address - Country:US
Practice Address - Phone:203-247-4500
Practice Address - Fax:203-247-4500
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
13798225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner