Individual provider Active NPI

Joanna Lee Selfors

  • Acute Care Nurse Practitioner
  • Oceanside, NY
National Provider Identifier
1255048674
Registry record updated Apr 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
433126 Issued in NY
Practice address
234 Evans Ave
Oceanside, NY 11572-3802
Phone
(646) 713-4618
NPI assigned
Nov 4, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Registered Nurse 163WC0200X 753841 NY
Acute Care Nurse Practitioner 363LA2100X 433126 NY Primary

Addresses

Primary practice location

234 Evans Ave
Oceanside, NY 11572-3802

Mailing address

234 Evans Ave
Oceanside, NY 11572-3802
Phone (646) 713-4618

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
753841NYMDCritical Care Medicine Registered Nurse
433126NYMDAcute Care Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744934400000",
    "number": "1255048674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "234 EVANS AVE",
            "city": "OCEANSIDE",
            "state": "NY",
            "postal_code": "115723802",
            "telephone_number": "646-713-4618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 EVANS AVE",
            "city": "OCEANSIDE",
            "state": "NY",
            "postal_code": "115723802",
            "telephone_number": "646-713-4618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELFORS",
        "first_name": "JOANNA",
        "middle_name": "LEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-04",
        "last_updated": "2025-04-18",
        "certification_date": "2025-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "NY",
            "license": "753841",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NY",
            "license": "433126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oceanside, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.