1811153109 NPI number — DR. SHANNON ELIZEBETHANN TAYLOR PHD

Table of content: DR. SHANNON ELIZEBETHANN TAYLOR PHD (NPI 1811153109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811153109 NPI number — DR. SHANNON ELIZEBETHANN TAYLOR PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
SHANNON
Provider Middle Name:
ELIZEBETHANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811153109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9555 LEBANON RD.
Provider Second Line Business Mailing Address:
SUITE 902
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-872-4411
Provider Business Mailing Address Fax Number:
844-270-4023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9555 LEBANON RD.
Provider Second Line Business Practice Location Address:
SUITE 902
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-872-4411
Provider Business Practice Location Address Fax Number:
844-270-4023
Provider Enumeration Date:
08/06/2008

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: 103G00000X , with the licence number:  33832 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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