Healthcare Provider Details

I. General information

NPI: 1295852457
Provider Name (Legal Business Name): CYNTHIA TAYLOR REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CYNTHIA TAYLOR LICENSED PRACTICAL N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MCCLELLAN AVENUE SUITE 300
PENNSAUKEN NJ
08109
US

IV. Provider business mailing address

2500 MCCLELLAN BLVD
PENNSAUKEN NJ
08109-4613
US

V. Phone/Fax

Practice location:
  • Phone: 856-361-1100
  • Fax: 856-488-1450
Mailing address:
  • Phone: 856-745-0572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number26NP05035800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: