Healthcare Provider Details

I. General information

NPI: 1154366805
Provider Name (Legal Business Name): TANISHA KADENE TAYLOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 BRUNSWICK AVE
TRENTON NJ
08638-3829
US

IV. Provider business mailing address

832 BRUNSWICK AVE
TRENTON NJ
08638-3829
US

V. Phone/Fax

Practice location:
  • Phone: 609-695-7471
  • Fax: 609-393-5272
Mailing address:
  • Phone: 609-695-7471
  • Fax: 609-393-5272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number042698
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number5MA08113000
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5MA08113000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: