Healthcare Provider Details

I. General information

NPI: 1366012734
Provider Name (Legal Business Name): TAYLOR RAE CHESNET AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 CREAMERY WAY STE 103
EXTON PA
19341-2533
US

IV. Provider business mailing address

523 GORGAS LN
PHILADELPHIA PA
19128-2447
US

V. Phone/Fax

Practice location:
  • Phone: 610-384-8300
  • Fax:
Mailing address:
  • Phone: 484-889-9447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00114500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT006774
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: