Provider Demographics
NPI:1659356038
Name:TAYLOR, SHALU R (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:SHALU
Middle Name:R
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 FERNCREST DR
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-1863
Mailing Address - Country:US
Mailing Address - Phone:478-553-1620
Mailing Address - Fax:478-864-1288
Practice Address - Street 1:616 FERNCREST DR
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-1863
Practice Address - Country:US
Practice Address - Phone:478-553-1620
Practice Address - Fax:478-864-1288
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN174968363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA994260837AMedicaid
GARN174968OtherGEORGIA LICENSE
GA994260837BMedicaid