Provider Demographics
NPI:1477056133
Name:TAYLOR, LEAH
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
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 1:1111 KENNEDY CT APT 12
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-4060
Mailing Address - Country:US
Mailing Address - Phone:770-500-7265
Mailing Address - Fax:321-567-2776
Practice Address - Street 1:1111 KENNEDY CT APT 12
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-4060
Practice Address - Country:US
Practice Address - Phone:770-500-7265
Practice Address - Fax:321-567-2776
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator