Provider Demographics
NPI:1386377810
Name:RONEY, SELENA STAR (CSFA, CST)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:STAR
Last Name:RONEY
Suffix:
Gender:F
Credentials:CSFA, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 WARRIORS WAY
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6891
Mailing Address - Country:US
Mailing Address - Phone:912-321-1218
Mailing Address - Fax:
Practice Address - Street 1:92 WARRIORS WAY
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6891
Practice Address - Country:US
Practice Address - Phone:912-321-1218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA203653246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant