Provider Demographics
NPI:1710357025
Name:TAYLOR, SAMUEL PAUL
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:PAUL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 VANDERBILT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2525
Mailing Address - Country:US
Mailing Address - Phone:718-981-4382
Mailing Address - Fax:
Practice Address - Street 1:285 VANDERBILT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2525
Practice Address - Country:US
Practice Address - Phone:718-981-4382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health