Provider Demographics
NPI:1598219644
Name:GRIFFIN, TAYLOR RAESHAUD
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RAESHAUD
Last Name:GRIFFIN
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 1:1217 SHRIVER AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-1533
Mailing Address - Country:US
Mailing Address - Phone:330-209-6912
Mailing Address - Fax:
Practice Address - Street 1:1217 SHRIVER AVE N.E
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-2751
Practice Address - Country:US
Practice Address - Phone:330-209-6912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-06
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide