Provider Demographics
NPI:1205530359
Name:TAYLOR, CHANELLE
Entity type:Individual
Prefix:
First Name:CHANELLE
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 1:1248 LOGAN AVE NW APT 4
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44703-3227
Mailing Address - Country:US
Mailing Address - Phone:330-775-4134
Mailing Address - Fax:
Practice Address - Street 1:1248 LOGAN AVE NW APT 4
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703-3227
Practice Address - Country:US
Practice Address - Phone:330-775-4134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care