Provider Demographics
NPI:1811153109
Name:TAYLOR, SHANNON ELIZEBETHANN (PHD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:ELIZEBETHANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9555 LEBANON RD.
Mailing Address - Street 2:SUITE 902
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035
Mailing Address - Country:US
Mailing Address - Phone:214-872-4411
Mailing Address - Fax:844-270-4023
Practice Address - Street 1:9555 LEBANON RD.
Practice Address - Street 2:SUITE 902
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035
Practice Address - Country:US
Practice Address - Phone:214-872-4411
Practice Address - Fax:844-270-4023
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX33832103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist