Healthcare Provider Details

I. General information

NPI: 1992409528
Provider Name (Legal Business Name): REDDHYIA JEAN TAYLOR DO, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 BRANDYWINE RD #125
BRANDYWINE MD
20613
US

IV. Provider business mailing address

9101 FRANKLIN SQUARE DR # 3009101
ROSEDALE MD
21237-3936
US

V. Phone/Fax

Practice location:
  • Phone: 301-782-2220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0107618
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: