Healthcare Provider Details

I. General information

NPI: 1417748377
Provider Name (Legal Business Name): SHANIECA TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 MIKE PADGETT HWY
AUGUSTA GA
30906-3815
US

IV. Provider business mailing address

PO BOX 117
EVANS GA
30809-0117
US

V. Phone/Fax

Practice location:
  • Phone: 706-432-4800
  • Fax:
Mailing address:
  • Phone: 347-248-8605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP339941
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: