Provider Demographics
NPI:1376967208
Name:TAYLOR, LESLIE ELISABETH (MSED)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ELISABETH
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 LOMOND CT
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5951
Mailing Address - Country:US
Mailing Address - Phone:315-754-4286
Mailing Address - Fax:315-754-4170
Practice Address - Street 1:130 LOMOND CT
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5951
Practice Address - Country:US
Practice Address - Phone:315-754-4286
Practice Address - Fax:315-754-4170
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY978544174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist