Provider Demographics
NPI:1972988707
Name:TAYLOR, SANDRA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 W 9TH PL. SOUTH
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-0000
Mailing Address - Country:US
Mailing Address - Phone:918-342-1203
Mailing Address - Fax:
Practice Address - Street 1:906 W 9TH PL. SOUTH
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-0000
Practice Address - Country:US
Practice Address - Phone:918-342-1203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service