Healthcare Provider Details

I. General information

NPI: 1841027976
Provider Name (Legal Business Name): AYANNA JUDITH TAITT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 PASEO VERDE PKWY STE 155
HENDERSON NV
89074-7120
US

IV. Provider business mailing address

3161 SUNRIDGE HEIGHTS PKWY UNIT 1213
HENDERSON NV
89052-5091
US

V. Phone/Fax

Practice location:
  • Phone: 702-515-4009
  • Fax:
Mailing address:
  • Phone: 773-681-4995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-4049
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: