Healthcare Provider Details

I. General information

NPI: 1417549817
Provider Name (Legal Business Name): TAYLOR SCIPIONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2021
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 CHARLES H DIMMOCK PKWY STE 100
COLONIAL HEIGHTS VA
23834-2990
US

IV. Provider business mailing address

445 CHARLES H DIMMOCK PKWY STE 100
COLONIAL HEIGHTS VA
23834-2990
US

V. Phone/Fax

Practice location:
  • Phone: 804-520-1764
  • Fax:
Mailing address:
  • Phone: 804-520-1764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110009363
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: