Provider Demographics
NPI:1770389314
Name:LOPEZ-TAYLOR, SOPHIA (RN)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:LOPEZ-TAYLOR
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 DOUBLE CREST DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-4638
Mailing Address - Country:US
Mailing Address - Phone:917-482-5786
Mailing Address - Fax:
Practice Address - Street 1:4893 WADE HAMPTON BLVD STE C
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-5247
Practice Address - Country:US
Practice Address - Phone:917-482-5786
Practice Address - Fax:803-716-8781
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC270356163W00000X, 163WA2000X
174200000X, 373H00000X, 261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No174200000XOther Service ProvidersMeals
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist