Provider Demographics
NPI:1063212934
Name:TAYLOR, SHANTEL
Entity type:Individual
Prefix:MRS
First Name:SHANTEL
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 SMITHTOWN BLVD UNIT 961
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-2081
Mailing Address - Country:US
Mailing Address - Phone:516-500-7161
Mailing Address - Fax:
Practice Address - Street 1:279 SMITHTOWN BLVD UNIT 961
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-2081
Practice Address - Country:US
Practice Address - Phone:516-500-7161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula