Provider Demographics
NPI:1710609557
Name:ROBERTS, TAYLOR (CRNA)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:DR
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:SHERECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 CROSBY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2509
Mailing Address - Country:US
Mailing Address - Phone:701-351-3234
Mailing Address - Fax:
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3175
Practice Address - Country:US
Practice Address - Phone:207-662-2526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERNA223054367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered