Provider Demographics
NPI:1972386746
Name:SIMON, TAYLOR JORDAN (NP)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:JORDAN
Last Name:SIMON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 DENROSE DR APT 3
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2638
Mailing Address - Country:US
Mailing Address - Phone:716-392-5884
Mailing Address - Fax:
Practice Address - Street 1:85 BRYANT WOODS S
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-3604
Practice Address - Country:US
Practice Address - Phone:716-689-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF405054-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health