Individual
VADIM SELYUKOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8815 GERMANTOWN AVE STE 16, PHILADELPHIA, PA 19118-2722
(215) 242-1159
Mailing address
1102 LITTLE LN, WARMINSTER, PA 18974-1963
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
SP019675
PA
Other
Enumeration date
11/29/2018
Last updated
06/27/2019
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