Healthcare Provider Details

I. General information

NPI: 1053061770
Provider Name (Legal Business Name): TAYLOR BROOKE VARELA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR BROOKE SIMPSON DO

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 WELLNESS WAY
STATE COLLEGE PA
16803-6797
US

IV. Provider business mailing address

155 WELLNESS WAY
STATE COLLEGE PA
16803-6702
US

V. Phone/Fax

Practice location:
  • Phone: 814-231-7168
  • Fax: 814-235-7381
Mailing address:
  • Phone: 814-231-7100
  • Fax: 814-238-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS025902
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: