Provider Demographics
NPI:1629593421
Name:SARDAR, TAYMOOR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TAYMOOR
Middle Name:
Last Name:SARDAR
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 N MAIN ST STE 501
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-4952
Mailing Address - Country:US
Mailing Address - Phone:920-478-1089
Mailing Address - Fax:
Practice Address - Street 1:404 N. MAIN ST.
Practice Address - Street 2:SUITE 501
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901
Practice Address - Country:US
Practice Address - Phone:920-478-1089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3243-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist