Healthcare Provider Details

I. General information

NPI: 1679049324
Provider Name (Legal Business Name): MRS. TAYLOR MICHELLE SEHORN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2018
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20950 N TATUM BLVD STE 190
PHOENIX AZ
85050-4251
US

IV. Provider business mailing address

3150 E BEARDSLEY RD UNIT 1017
PHOENIX AZ
85050-3561
US

V. Phone/Fax

Practice location:
  • Phone: 480-776-0021
  • Fax:
Mailing address:
  • Phone: 480-862-4417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: