Provider Demographics
NPI:1316553464
Name:KERESTESY, SELINA MARIA
Entity type:Individual
Prefix:
First Name:SELINA
Middle Name:MARIA
Last Name:KERESTESY
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 1:9875 JOHNNYCAKE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6748
Mailing Address - Country:US
Mailing Address - Phone:440-358-1559
Mailing Address - Fax:440-358-1567
Practice Address - Street 1:9875 JOHNNYCAKE RIDGE RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6748
Practice Address - Country:US
Practice Address - Phone:440-358-1559
Practice Address - Fax:440-358-1567
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03432237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist