Provider Demographics
NPI:1093449399
Name:MCELROY, TAISA SHENEZ (CERTIFIED NURSE AIDE)
Entity Type:Individual
Prefix:
First Name:TAISA
Middle Name:SHENEZ
Last Name:MCELROY
Suffix:
Gender:F
Credentials:CERTIFIED NURSE AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N SAINT MARYS ST APT 303
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1104
Mailing Address - Country:US
Mailing Address - Phone:210-876-7795
Mailing Address - Fax:
Practice Address - Street 1:1500 N SAINT MARYS ST APT 303
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1104
Practice Address - Country:US
Practice Address - Phone:210-876-7795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0010093004172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty