Provider Demographics
NPI:1336968585
Name:TAYKO, SANDY
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:TAYKO
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 1:7995 BLUE DIAMOND RD # 102-304
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-9301
Mailing Address - Country:US
Mailing Address - Phone:702-848-6070
Mailing Address - Fax:
Practice Address - Street 1:7995 BLUE DIAMOND RD # 102-304
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-9301
Practice Address - Country:US
Practice Address - Phone:702-848-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician