Provider Demographics
NPI:1760952972
Name:TAYLOR, SHAHEEN (LMT)
Entity Type:Individual
Prefix:MS
First Name:SHAHEEN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 KESWICK CT
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-1728
Mailing Address - Country:US
Mailing Address - Phone:469-990-4130
Mailing Address - Fax:
Practice Address - Street 1:210-B SOUTH CEDAR RIDGE DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4583
Practice Address - Country:US
Practice Address - Phone:469-866-1896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT129372225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty