Healthcare Provider Details

I. General information

NPI: 1598287054
Provider Name (Legal Business Name): TAYLOR STAUDT DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAYLOR WASSERLEBEN DPM

II. Dates (important events)

Enumeration Date: 07/16/2017
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 CENTERVILLE BUSINESS PKWY STE 117
DAYTON OH
45459-2690
US

IV. Provider business mailing address

10280 GATEWAY PL UNIT 300
BLUE ASH OH
45242-4692
US

V. Phone/Fax

Practice location:
  • Phone: 937-296-9806
  • Fax: 937-296-9805
Mailing address:
  • Phone: 267-257-4931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC006876
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: