Healthcare Provider Details

I. General information

NPI: 1205374105
Provider Name (Legal Business Name): TAYLOR PIATKOWSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2017
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE CLEVELAND CLINIC 9500 EUCLID AVENUE
CLEVELAND OH
44195
US

IV. Provider business mailing address

1107 AQUA MARINE BLVD
AVON LAKE OH
44012-2576
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-5461
  • Fax:
Mailing address:
  • Phone: 419-705-3796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.005017RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: