Provider Demographics
NPI:1528074770
Name:TAYLOR, SHANNAN NATALIE (MA)
Entity type:Individual
Prefix:MRS
First Name:SHANNAN
Middle Name:NATALIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:SHANNAN
Other - Middle Name:NATALIE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:900 FULTON AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4517
Mailing Address - Country:US
Mailing Address - Phone:916-484-3570
Mailing Address - Fax:916-484-3570
Practice Address - Street 1:900 FULTON AVE
Practice Address - Street 2:205
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4500
Practice Address - Country:US
Practice Address - Phone:916-484-3570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43834106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist