Healthcare Provider Details

I. General information

NPI: 1679482939
Provider Name (Legal Business Name): TAYLOR GRACE KRASNOMOWITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 S TRYON ST
CHARLOTTE NC
28202-5001
US

IV. Provider business mailing address

8216 GALLISON AVE APT 11310
LELAND NC
28451-7062
US

V. Phone/Fax

Practice location:
  • Phone: 973-862-2155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: