1780705335 NPI number — DR. SHARONDA JANEYA ALSTON TAYLOR MD

Table of content: DR. SHARONDA JANEYA ALSTON TAYLOR MD (NPI 1780705335)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780705335 NPI number — DR. SHARONDA JANEYA ALSTON TAYLOR MD

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
TAYLOR

Provider First Name:
SHARONDA

Provider Middle Name:
JANEYA ALSTON

Provider Name Prefix Text:
DR.

Provider Name Suffix Text:

Provider Credential Text:
MD

Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:
ALSTON

Provider Other First Name:
SHARONDA

Provider Other Middle Name:
JANEYA

Provider Other Name Prefix Text:
DR.

Provider Other Name Suffix Text:

Provider Other Credential Text:
MD

Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780705335

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
08/17/2011

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13326 MONTCLAIR POINT CT

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
HOUSTON

Provider Business Mailing Address State Name:
TX

Provider Business Mailing Address Postal Code:
77047-2764

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
713-433-0464

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6701 FANNIN ST

Provider Second Line Business Practice Location Address:
CC 1710.00

Provider Business Practice Location Address City Name:
HOUSTON

Provider Business Practice Location Address State Name:
TX

Provider Business Practice Location Address Postal Code:
77030-2608

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
832-822-3660

Provider Business Practice Location Address Fax Number:
832-825-3689

Provider Enumeration Date:
04/02/2007

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: 208000000X , with the licence number: M5949 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Taxonomy code: 2080A0000X , with the licence number: M5949 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .