Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS14936 | FL |
N | 207Q00000X | Family Doctor | OS14936 | FL |
NPI | 1639538143 |
---|---|
Provider Name | Dr. Amy Joy Selwach |
First Address | Cocoa, FL 32922-7008 |
Second Address | Cocoa, FL 32922-7588 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2016 |
Last Update Date | 31/01/2021 |