MEDICARE: SHELLEY ANN TAYLOR MA, LLP

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	103TC0700X	Clinical Psychologist	6361003484	MI

General Provider Information

NPI Number	:	1902159759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY ANN TAYLOR MA, LLP

Provider Business Mailing Address
First Line	:	248 WOODED VALLEY DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49696-8731
Country	:	US
Telephone Number	:	248-672-9275
Fax Number	:

Provider Business Practice Location Address
First Line	:	248 WOODED VALLEY DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49696-8731
Country	:	US
Telephone Number	:	248-672-9275
Fax Number	:

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

Provider Enumeration Date	:	10/17/2012
Last Update Date	:	07/17/2025

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