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General NPI Number Information
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NPI Number | 1568045169
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Entity Type | Individual
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Provider Name | DEJA TAYLOR
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Gender | Female
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 4068 GALLATIN DR
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City | OBETZ
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State | OH
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Zip | 43207-4391
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Country | US
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Telephone | 631-633-1524
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Fax |
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Provider Business Mailing Address
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Address Line | 5306 RIFLE DR
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City | CANAL WINCHESTER
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State | OH
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Zip | 43110-9061
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Country | US
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Telephone | 614-323-2204
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 374K00000X
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Taxonomy Name | Religious Nonmedical Practitioner
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License Number |
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License Number State |
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