Healthcare Provider Details

I. General information

NPI: 1104744614
Provider Name (Legal Business Name): MARY-LYN P TAYLOR-SMITH MSCN, LE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY TAYLOR-SMITH MSCN, LE

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16825 SHINHAM RD
HAGERSTOWN MD
21740-2216
US

IV. Provider business mailing address

16825 SHINHAM RD
HAGERSTOWN MD
21740-2216
US

V. Phone/Fax

Practice location:
  • Phone: 781-307-2974
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: