Healthcare Provider Details

I. General information

NPI: 1427075092
Provider Name (Legal Business Name): MICHELLE RENEE TAYLOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

863 N MAIN STREET EXT STE 301
WALLINGFORD CT
06492-2434
US

IV. Provider business mailing address

863 N MAIN STREET EXT STE 301
WALLINGFORD CT
06492-2434
US

V. Phone/Fax

Practice location:
  • Phone: 203-269-0885
  • Fax: 203-269-3496
Mailing address:
  • Phone: 203-269-0885
  • Fax: 203-269-3496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number044278
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: