Provider Demographics
NPI:1790004455
Name:TAYLOR, ADIA KAMALI (DO)
Entity Type:Individual
Prefix:
First Name:ADIA
Middle Name:KAMALI
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:CORFU
Mailing Address - State:NY
Mailing Address - Zip Code:14036-9753
Mailing Address - Country:US
Mailing Address - Phone:585-599-6446
Mailing Address - Fax:
Practice Address - Street 1:2905 W WARNER RD STE 12
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-1674
Practice Address - Country:US
Practice Address - Phone:480-831-8457
Practice Address - Fax:480-491-3112
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281032207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine