Individual
SIMON MAURICE SEBASTIAN SELWYN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
465 WAVERLY OAKS RD, WALTHAM, MA 02452-8438
(617) 596-1975
Mailing address
465 WAVERLY OAKS RD STE 416, WALTHAM, MA 02452-8401
(617) 596-1975
(781) 735-0457
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN2284419
MA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2284419
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN2284419
NURSING REGISTRATION BOARD
MA
Enumeration date
07/31/2018
Last updated
03/25/2024
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