Provider Demographics
NPI:1083449425
Name:TAYLOR, SHANIN L
Entity type:Individual
Prefix:
First Name:SHANIN
Middle Name:L
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 1:4820 SEVILLE DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-3529
Mailing Address - Country:US
Mailing Address - Phone:937-624-0924
Mailing Address - Fax:
Practice Address - Street 1:4820 SEVILLE DR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-3529
Practice Address - Country:US
Practice Address - Phone:937-624-0924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No347C00000XTransportation ServicesPrivate Vehicle