Provider Demographics
NPI:1619111473
Name:DEFELICE, TAYLOR M (MD)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:M
Last Name:DEFELICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 BANDYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2968
Mailing Address - Country:US
Mailing Address - Phone:615-679-9011
Mailing Address - Fax:615-891-4753
Practice Address - Street 1:2125 BANDYWOOD DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2968
Practice Address - Country:US
Practice Address - Phone:615-679-9011
Practice Address - Fax:615-891-4753
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254121207N00000X
TN66247207ND0101X, 207N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program