Healthcare Provider Details

I. General information

NPI: 1306227426
Provider Name (Legal Business Name): STEPHANIE TRAYLOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE AMBER MALLERY

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 TAYLOR AVE
COLUMBUS OH
43203-1779
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-9600
  • Fax: 614-293-1456
Mailing address:
  • Phone: 614-293-9600
  • Fax: 614-293-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35133723
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35.133723
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301107856
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number35.133723
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: