Provider Demographics
NPI:1972703957
Name:SELVARATNAM, SHARLENE (MD)
Entity type:Individual
Prefix:
First Name:SHARLENE
Middle Name:
Last Name:SELVARATNAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 E HEBRON PKWY STE 114
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-1601
Mailing Address - Country:US
Mailing Address - Phone:206-409-6200
Mailing Address - Fax:
Practice Address - Street 1:2008 E HEBRON PKWY STE 114
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-1601
Practice Address - Country:US
Practice Address - Phone:469-431-0544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA232570207Q00000X
TXQ7467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine