Provider Demographics
NPI:1851701528
Name:TAYLOR, SHANE ANDREW
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:ANDREW
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 1:640 WEST ST
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:MA
Mailing Address - Zip Code:01005-9141
Mailing Address - Country:US
Mailing Address - Phone:508-344-2747
Mailing Address - Fax:
Practice Address - Street 1:640 WEST ST
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:MA
Practice Address - Zip Code:01005-9141
Practice Address - Country:US
Practice Address - Phone:508-344-2747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor