Provider Demographics
NPI:1881783728
Name:TAYLOR, SHAWN D (PA-C)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:D
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 PALM BLVD S
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2603
Mailing Address - Country:US
Mailing Address - Phone:850-517-9851
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL RD
Practice Address - Street 2:CHEROKEE INDIAN HOSPITAL
Practice Address - City:CHEROKEE
Practice Address - State:NC
Practice Address - Zip Code:28719
Practice Address - Country:US
Practice Address - Phone:828-497-9163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9104301363AM0700X, 363AM0700X
FLPA9104301363A00000X
NC0010-03253363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA116970777BMedicaid
GAQ08217Medicare UPIN
GA97WCFHJMedicare ID - Type UnspecifiedFAIRVIEW PARK/STERLING
GA116970777BMedicaid