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NPI Code Detail

MEDICARE: SHANICE L TAYLOR

MEDICARE: SHANICE L TAYLOR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1174278840
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANICE L TAYLOR
Provider Business Mailing Address
First Line : 3007 HARBOR LN N
Second Line :
City : PLYMOUTH
State : MN
Zip : 55447-5112
Country : US
Telephone Number : 612-439-4650
Fax Number :
Provider Business Practice Location Address
First Line : 3007 HARBOR LN N
Second Line :
City : PLYMOUTH
State : MN
Zip : 55447-5112
Country : US
Telephone Number : 612-439-4650
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2022
Last Update Date : 11/07/2024

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Directions to “ SHANICE L TAYLOR ” Practice Location

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