Provider Demographics
NPI:1487474029
Name:TAYLOR, SANDRA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
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 1:255 S POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:DRESDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38225-1331
Mailing Address - Country:US
Mailing Address - Phone:931-607-8607
Mailing Address - Fax:
Practice Address - Street 1:255 S POPLAR ST
Practice Address - Street 2:
Practice Address - City:DRESDEN
Practice Address - State:TN
Practice Address - Zip Code:38225-1331
Practice Address - Country:US
Practice Address - Phone:931-607-8607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home