Provider Demographics
NPI:1346375219
Name:TAYLOR, SHELLY LYNN (APRN)
Entity Type:Individual
Prefix:MISS
First Name:SHELLY
Middle Name:LYNN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 ARNDELL RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:42273-8359
Mailing Address - Country:US
Mailing Address - Phone:239-848-6390
Mailing Address - Fax:
Practice Address - Street 1:300 SEASIDE AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4603
Practice Address - Country:US
Practice Address - Phone:203-688-1734
Practice Address - Fax:475-246-9106
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2879292363LP2300X
CT12765363LF0000X
KY3015904363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP 2879292OtherSTATE LICENSE