Provider Demographics
NPI:1326302217
Name:TAYLOR, JOAN DIANA (556499041)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:DIANA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:556499041
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183 GRENADA PL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-5019
Mailing Address - Country:US
Mailing Address - Phone:407-572-7388
Mailing Address - Fax:
Practice Address - Street 1:1183 GRENADA PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-5019
Practice Address - Country:US
Practice Address - Phone:407-572-7388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY556499041174400000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No174400000XOther Service ProvidersSpecialist