Individual
DEEPAN SELVADURAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3055 SOUTHWESTERN BLVD STE 108, ORCHARD PARK, NY 14127-1231
(716) 671-9020
Mailing address
405 INTERNATIONAL DR, WILLIAMSVILLE, NY 14221-5725
(716) 633-7386
(716) 204-3166
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
258143
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03256860
—
NY
05
—
719437000
—
MN
Enumeration date
08/08/2006
Last updated
03/30/2021
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