Provider Demographics
NPI:1063008472
Name:TAYLOR, TERRELL D
Entity Type:Individual
Prefix:
First Name:TERRELL
Middle Name:D
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10808 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-3018
Mailing Address - Country:US
Mailing Address - Phone:216-634-9391
Mailing Address - Fax:
Practice Address - Street 1:10808 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-3018
Practice Address - Country:US
Practice Address - Phone:216-634-9391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide