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General NPI Number Information
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NPI Number | 1235740960
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Entity Type | Individual
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Provider Name | TAYLOR LIN NEDURIAN PA
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Gender | Female
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Dates
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Enumeration Date | 08/14/2020
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 285 COUNTY ROUTE 47
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City | SARANAC LAKE
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State | NY
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Zip | 12983-5403
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Country | US
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Telephone | 518-897-2850
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Fax | 518-897-2812
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Provider Business Mailing Address
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Address Line | 112 TURTLE POND RD
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City | SARANAC LAKE
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State | NY
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Zip | 12983-2458
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA062693
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 4941
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 025536
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License Number State | NY
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