Healthcare Provider Details

I. General information

NPI: 1285368845
Provider Name (Legal Business Name): SHANNON NICOLE TAYLOR TOWNSEND DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANNON NICOLE TAYLOR DDS

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DR
GAINESVILLE FL
32611-2025
US

IV. Provider business mailing address

8249 NW 53RD TER
GAINESVILLE FL
32653-6142
US

V. Phone/Fax

Practice location:
  • Phone: 407-394-6897
  • Fax:
Mailing address:
  • Phone: 407-394-6897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDGD.10281
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDRPM3064
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401419287
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: