Provider Demographics
NPI:1134819063
Name:FLEURISSAINT, TAYLOR (M ED)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:FLEURISSAINT
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 PARKHILL CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-9094
Mailing Address - Country:US
Mailing Address - Phone:646-320-7177
Mailing Address - Fax:
Practice Address - Street 1:1047 PARKHILL CIR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-9094
Practice Address - Country:US
Practice Address - Phone:646-320-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist