Provider Demographics
NPI:1770328668
Name:TAYLOR, ASIEL SHANNON SR
Entity type:Individual
Prefix:
First Name:ASIEL
Middle Name:SHANNON
Last Name:TAYLOR
Suffix:SR
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 1:3702 ALMEDA GENOA RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-3833
Mailing Address - Country:US
Mailing Address - Phone:414-467-1303
Mailing Address - Fax:
Practice Address - Street 1:3702 ALMEDA GENOA RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-3833
Practice Address - Country:US
Practice Address - Phone:414-467-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle