Healthcare Provider Details

I. General information

NPI: 1093691057
Provider Name (Legal Business Name): TAMYA TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 HADDONFIELD RD WEST BUILDING SUITE 110
PENNSAUKEN NJ
08109
US

IV. Provider business mailing address

2252 HORNER AVE
PENNSAUKEN NJ
08110-1717
US

V. Phone/Fax

Practice location:
  • Phone: 856-406-0035
  • Fax:
Mailing address:
  • Phone: 856-203-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-461532
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: