Healthcare Provider Details

I. General information

NPI: 1215683230
Provider Name (Legal Business Name): TAYLOR J RICHARDS SUDPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 AIRPORT WAY S
SEATTLE WA
98134-1618
US

IV. Provider business mailing address

2317 3RD AVE APT 208
SEATTLE WA
98121-1732
US

V. Phone/Fax

Practice location:
  • Phone: 206-223-3644
  • Fax:
Mailing address:
  • Phone: 206-741-4513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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: