Healthcare Provider Details

I. General information

NPI: 1942825773
Provider Name (Legal Business Name): TAYLOR LYON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE SHAPIRO 3
BOSTON MA
02215-5400
US

IV. Provider business mailing address

330 BROOKLINE AVE SHAPIRO 3
BOSTON MA
02215-5491
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-3739
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number58406
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA101937
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAMD-1285
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: