Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 257467 | NY |
N | 207WX0107X | Retina Specialist | 257467 | NY |
NPI | 1023297892 |
---|---|
Provider Name | Dr. Ausra Selvadurai |
First Address | Williamsville, NY 14221-5725 |
Second Address | Williamsville, NY 14221-5725 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2007 |
Last Update Date | 05/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03240526 | (05) | NY |