MEDICARE: TAYLOR VICKERY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558015230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR VICKERY

Provider Business Mailing Address
First Line	:	1725 NANTUCKETT LN APT 208
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-3318
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3790 DAIRY RD STE 108
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32904-7630
Country	:	US
Telephone Number	:	813-219-3311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2022
Last Update Date	:	05/07/2026

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Directions to “ TAYLOR VICKERY ” Practice Location

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