Healthcare Provider Details

I. General information

NPI: 1104424258
Provider Name (Legal Business Name): SOPHIA TAYLOR AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE 10TH ST STE 4C
OKLAHOMA CITY OK
73104-5417
US

IV. Provider business mailing address

825 NE 10TH ST STE 4C
OKLAHOMA CITY OK
73104-5417
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-1368
  • Fax: 405-271-3248
Mailing address:
  • Phone: 405-271-1368
  • Fax: 405-271-3248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA-3085
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number6498
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: