Provider Demographics
NPI:1154043602
Name:TAYLOR, SOPHIA (LPN,IBCLC)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPN,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7272 SHELLBURNE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2480
Mailing Address - Country:US
Mailing Address - Phone:919-862-3479
Mailing Address - Fax:
Practice Address - Street 1:7272 SHELLBURNE DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2480
Practice Address - Country:US
Practice Address - Phone:919-862-3479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL-311772174N00000X
NC89069164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89069OtherLICENSED PRACTICAL NURSE
NC330702OtherCERTIFIED LACTATION COUNSELOR CLC THROUGH ALPP
NCL-311772OtherIBLCE