1811316045 NPI number — SHAYNE SEBOLD TAYLOR M.D.

Table of content: SHAYNE SEBOLD TAYLOR M.D. (NPI 1811316045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811316045 NPI number — SHAYNE SEBOLD TAYLOR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
SHAYNE
Provider Middle Name:
SEBOLD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SEBOLD
Provider Other First Name:
SHAYNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811316045
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 RESEARCH DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMHERST
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01002-2178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-549-8400
Provider Business Mailing Address Fax Number:
413-549-8409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 RESEARCH DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMHERST
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01002-2178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-549-8400
Provider Business Practice Location Address Fax Number:
413-549-8409
Provider Enumeration Date:
04/15/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 1016276 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)