Provider Demographics
NPI:1053967786
Name:KALDAS, SELVIA
Entity type:Individual
Prefix:
First Name:SELVIA
Middle Name:
Last Name:KALDAS
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 1:480 GRANDVIEW AVE APT 2L
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1953
Mailing Address - Country:US
Mailing Address - Phone:347-779-3268
Mailing Address - Fax:
Practice Address - Street 1:711 BEDFORD AVE APT 2L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5428
Practice Address - Country:US
Practice Address - Phone:347-779-3268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04015000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist