Provider Demographics
NPI:1366049348
Name:MENDES, SELINA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:SELINA
Middle Name:MARIE
Last Name:MENDES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 DEL CIRA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-5603
Mailing Address - Country:US
Mailing Address - Phone:860-249-9228
Mailing Address - Fax:
Practice Address - Street 1:100 N GREEN VALLEY PKWY STE 235
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7704
Practice Address - Country:US
Practice Address - Phone:725-333-8036
Practice Address - Fax:702-823-0316
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2320363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty