Healthcare Provider Details

I. General information

NPI: 1487267639
Provider Name (Legal Business Name): GRACE TAYLOR PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 5TH AVE FL 4
NEW YORK NY
10017-8020
US

IV. Provider business mailing address

PO BOX 67
BRONX NY
10467-0067
US

V. Phone/Fax

Practice location:
  • Phone: 212-477-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF403036-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: