Provider Demographics
NPI:1679379887
Name:SEWELL, SELVYN (DR)
Entity type:Individual
Prefix:DR
First Name:SELVYN
Middle Name:
Last Name:SEWELL
Suffix:
Gender:
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2301
Mailing Address - Country:US
Mailing Address - Phone:352-571-0274
Mailing Address - Fax:
Practice Address - Street 1:1725 E HWY 50 STE A
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5188
Practice Address - Country:US
Practice Address - Phone:352-719-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11057101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health