Healthcare Provider Details

I. General information

NPI: 1770722738
Provider Name (Legal Business Name): CHERILYN TAYLOR PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2009
Last Update Date: 02/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 BROAD ST
SUMTER SC
29150-4237
US

IV. Provider business mailing address

4300 ARLINGTON ST
COLUMBIA SC
29203-5872
US

V. Phone/Fax

Practice location:
  • Phone: 803-467-1263
  • Fax:
Mailing address:
  • Phone: 864-621-7055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1056
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: