Provider Demographics
NPI:1598287054
Name:STAUDT, TAYLOR (DPM)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:
Last Name:STAUDT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:WASSERLEBEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:10280 GATEWAY PL UNIT 300
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4692
Mailing Address - Country:US
Mailing Address - Phone:267-257-4931
Mailing Address - Fax:
Practice Address - Street 1:6601 CENTERVILLE BUSINESS PKWY STE 117
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-2690
Practice Address - Country:US
Practice Address - Phone:937-296-9806
Practice Address - Fax:937-296-9805
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-16
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006876213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty