Provider Demographics
NPI:1164674065
Name:TAYLOR, SHARON L
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
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 1:17 93RD ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3748
Mailing Address - Country:US
Mailing Address - Phone:603-924-7236
Mailing Address - Fax:
Practice Address - Street 1:9 VOSE FARM RD
Practice Address - Street 2:SUITE 120
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-2154
Practice Address - Country:US
Practice Address - Phone:603-924-7236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH81263595Medicaid