Healthcare Provider Details

I. General information

NPI: 1972149029
Provider Name (Legal Business Name): SASHA MATHEWS TAYLOR NMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21820 S ELLSWORTH RD STE 101
QUEEN CREEK AZ
85142-6177
US

IV. Provider business mailing address

21820 S ELLSWORTH RD STE 101
QUEEN CREEK AZ
85142-6177
US

V. Phone/Fax

Practice location:
  • Phone: 480-296-6173
  • Fax:
Mailing address:
  • Phone: 480-296-6173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number19-1824
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: