Provider Demographics
NPI:1891765855
Name:SELLARS, CARL (PA)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:SELLARS
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 UNDERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1118
Mailing Address - Country:US
Mailing Address - Phone:407-872-1110
Mailing Address - Fax:407-839-4869
Practice Address - Street 1:63 UNDERWOOD ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1118
Practice Address - Country:US
Practice Address - Phone:407-872-1110
Practice Address - Fax:407-839-4869
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
FLPA9103455363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS86234Medicare UPIN