Healthcare Provider Details

I. General information

NPI: 1013793090
Provider Name (Legal Business Name): TAYLOR CHERIPKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14995 SHADY GROVE RD STE 250
ROCKVILLE MD
20850-8727
US

IV. Provider business mailing address

14995 SHADY GROVE RD STE 250
ROCKVILLE MD
20850-8727
US

V. Phone/Fax

Practice location:
  • Phone: 301-942-7600
  • Fax: 301-217-9241
Mailing address:
  • Phone: 301-908-9522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: