Provider Demographics
NPI:1568428936
Name:SANDS, TAYLOR (MS, CCC-SLP, LSLS)
Entity Type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:
Last Name:SANDS
Suffix:
Gender:F
Credentials:MS, CCC-SLP, LSLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9803 OLD SAINT AUGUSTINE RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8854
Mailing Address - Country:US
Mailing Address - Phone:904-880-9001
Mailing Address - Fax:
Practice Address - Street 1:9803 OLD SAINT AUGUSTINE RD
Practice Address - Street 2:SUITE 7
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8854
Practice Address - Country:US
Practice Address - Phone:904-880-9001
Practice Address - Fax:904-880-9007
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 9256235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000770500Medicaid
FL000710600Medicaid