Provider Demographics
NPI:1962052373
Name:SCIRE, TAYLOR MICHELLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:MICHELLE
Last Name:SCIRE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:MICHELLE
Other - Last Name:ULLEMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:262 GASTON ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-1137
Mailing Address - Country:US
Mailing Address - Phone:720-209-2810
Mailing Address - Fax:
Practice Address - Street 1:330 MOUNT AUBURN STREET
Practice Address - Street 2:SUITE 313
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:617-349-2983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant