Provider Demographics
NPI:1265119101
Name:TAYLOR SMITH, JOAN
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:TAYLOR SMITH
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 1:27 SIEMON COMPANY DR STE 228W
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2654
Mailing Address - Country:US
Mailing Address - Phone:860-417-7309
Mailing Address - Fax:
Practice Address - Street 1:200 YALE ST UNIT 34B
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-1566
Practice Address - Country:US
Practice Address - Phone:860-417-7309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy