Provider Demographics
NPI:1962482117
Name:TAYLOR, LINDY ALLISON (MD)
Entity type:Individual
Prefix:DR
First Name:LINDY
Middle Name:ALLISON
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8647 BETTY ST
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-6044
Mailing Address - Country:US
Mailing Address - Phone:941-777-5159
Mailing Address - Fax:278-076-8297
Practice Address - Street 1:8647 BETTY ST
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6044
Practice Address - Country:US
Practice Address - Phone:941-777-5159
Practice Address - Fax:727-807-6829
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110686208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL725665Medicaid
OHH99902Medicare UPIN
OH4125501Medicare ID - Type Unspecified