Provider Demographics
NPI:1952612731
Name:SANN, TAYLOR AVERY (DPM)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:AVERY
Last Name:SANN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 HARVARD AVE UNIT 310
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4790
Mailing Address - Country:US
Mailing Address - Phone:206-234-7881
Mailing Address - Fax:
Practice Address - Street 1:16233 SYLVESTER RD SW STE G10
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3069
Practice Address - Country:US
Practice Address - Phone:206-242-6553
Practice Address - Fax:206-341-1250
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO60482833213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2058694Medicaid