MEDICARE: GRACE TAYLOR PMHNP-BC

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	F403036-01	NY

General Provider Information

NPI Number	:	1487267639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE TAYLOR PMHNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 67
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-0067
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 5TH AVE FL 4
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-8020
Country	:	US
Telephone Number	:	212-477-6100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2020
Last Update Date	:	12/30/2025

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