Provider Demographics
NPI:1659721561
Name:TAYLOR-SANDY, KELLY MICHELLE
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MICHELLE
Last Name:TAYLOR-SANDY
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 1:310 CHENEY HWY
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-7273
Mailing Address - Country:US
Mailing Address - Phone:321-362-5760
Mailing Address - Fax:
Practice Address - Street 1:310 CHENEY HWY
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-7273
Practice Address - Country:US
Practice Address - Phone:321-362-5760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst