Individual provider Active NPI

Sharlene Selvaratnam, M.D.

  • Family Medicine Physician
  • Carrollton, TX
National Provider Identifier
1972703957
Registry record updated Jun 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
Q7467 Issued in TX
Practice address
2008 E Hebron Pkwy Ste 114
Carrollton, TX 75007-1601
Phone
(469) 431-0544
NPI assigned
Jul 19, 2007
Last updated
Jun 29, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 232570 MA
Family Medicine Physician 207Q00000X Q7467 TX Primary

Addresses

Primary practice location

2008 E Hebron Pkwy Ste 114
Carrollton, TX 75007-1601

Mailing address

2008 E Hebron Pkwy Ste 114
Carrollton, TX 75007-1601
Phone (206) 409-6200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190416001177 TX Practitioner - Family Practice 8729267034 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Reshaped PLLCGroup PAC ID 9638419765, 6 clinicians

Practice addresses (Care Compare)

2008 E Hebron Pkwy
Suite 114
Carrollton, TX 75007-1601
Phone (469) 431-0544

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
232570MAMDFamily Medicine Physician
Q7467TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Reshaped PLLC CurrentSince Jan 22, 2019 Accepting new patients
Form Health Associates Ma, P.C. Family Medicine CurrentSince Aug 17, 2020 Accepting new patients

Locations

109 State St
Ste 5
Boston, MA 02109

2008 E Hebron Pkwy
Ste 114
Carrollton, TX 75007
Phone (469) 431-0544

Interoperability endpoints

  • Direct secure messaging: sharlene.selvaratnam.1@19284.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719619200000",
    "number": "1972703957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2008 E HEBRON PKWY STE 114",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750071601",
            "telephone_number": "206-409-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2008 E HEBRON PKWY STE 114",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750071601",
            "telephone_number": "469-431-0544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELVARATNAM",
        "first_name": "SHARLENE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-19",
        "last_updated": "2024-06-29",
        "certification_date": "2024-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "232570",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "Q7467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, TX

Sources for this page

Verify at the official NPI Registry.