Provider Demographics
NPI:1558002170
Name:TAYLOR, TAJUANA
Entity Type:Individual
Prefix:MS
First Name:TAJUANA
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 1:129 LAURA AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-3103
Mailing Address - Country:US
Mailing Address - Phone:937-977-0605
Mailing Address - Fax:
Practice Address - Street 1:129 LAURA AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-3103
Practice Address - Country:US
Practice Address - Phone:937-977-0605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2023-02-24
Deactivation Date:2023-01-20
Deactivation Code:
Reactivation Date:2023-02-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program