Provider Demographics
NPI:1033725031
Name:TAYLOR, MADISYN LEIGH
Entity Type:Individual
Prefix:
First Name:MADISYN
Middle Name:LEIGH
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 1:253 GREEN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:MOYOCK
Mailing Address - State:NC
Mailing Address - Zip Code:27958-9297
Mailing Address - Country:US
Mailing Address - Phone:757-746-4536
Mailing Address - Fax:
Practice Address - Street 1:108 ROCKY TOP RD
Practice Address - Street 2:
Practice Address - City:MOYOCK
Practice Address - State:NC
Practice Address - Zip Code:27958-9284
Practice Address - Country:US
Practice Address - Phone:757-769-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-20-134817247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other