Provider Demographics
NPI:1013463553
Name:TAYLOR, SHAKIRA
Entity Type:Individual
Prefix:
First Name:SHAKIRA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 SAWYER BLVD
Mailing Address - Street 2:611
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-1002
Mailing Address - Country:US
Mailing Address - Phone:216-334-8886
Mailing Address - Fax:
Practice Address - Street 1:2691 E MAIN ST
Practice Address - Street 2:103
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-2535
Practice Address - Country:US
Practice Address - Phone:614-237-6373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.023067225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist