Provider Demographics
NPI:1053386706
Name:SELPH, AMELIA K (APRN, ACNP)
Entity type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:K
Last Name:SELPH
Suffix:
Gender:F
Credentials:APRN, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 ST MATTHEWS RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-8201
Mailing Address - Country:US
Mailing Address - Phone:803-747-7242
Mailing Address - Fax:803-747-7243
Practice Address - Street 1:3045 ST MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-8201
Practice Address - Country:US
Practice Address - Phone:803-747-7242
Practice Address - Fax:803-747-7243
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN955174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC204031721Medicare ID - Type Unspecified
SCP37836Medicare UPIN
SCP378362040Medicare PIN