Provider Demographics
NPI:1063396398
Name:TAYLOR, IMANI MA'AT
Entity type:Individual
Prefix:
First Name:IMANI
Middle Name:MA'AT
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 W PHILADELPHIA ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-2475
Mailing Address - Country:US
Mailing Address - Phone:951-384-5412
Mailing Address - Fax:
Practice Address - Street 1:1521 W PHILADELPHIA ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-2475
Practice Address - Country:US
Practice Address - Phone:951-384-5412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker