Provider Demographics
NPI: | 1932590692 |
---|---|
Name: | ST. AMOUR, TAYLOR CAVANAUGH (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | TAYLOR |
Middle Name: | CAVANAUGH |
Last Name: | ST. AMOUR |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | DR |
Other - First Name: | TAYLOR |
Other - Middle Name: | CAVANAUGH |
Other - Last Name: | SUTCLIFFE |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | MD |
Mailing Address - Street 1: | 3841 GREEN HILLS VILLAGE DR STE 200 |
Mailing Address - Street 2: | |
Mailing Address - City: | NASHVILLE |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37215-2691 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 615-322-2363 |
Mailing Address - Fax: | 615-343-5365 |
Practice Address - Street 1: | 3601 THE VANDERBILT CLINIC |
Practice Address - Street 2: | |
Practice Address - City: | NASHVILLE |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37232-0001 |
Practice Address - Country: | US |
Practice Address - Phone: | 615-936-0605 |
Practice Address - Fax: | 615-936-0605 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2015-02-16 |
Last Update Date: | 2025-09-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | 64168 | 2086X0206X, 208600000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2086X0206X | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TN | Q041568 | Medicaid |