MEDICARE: SHILOH RAE TAYLOR M.S., CCC-SLP

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	235Z00000X	Speech-Language Pathologist	SA19702	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SA19702	OTHER	FL	DEPARTMENT OF HEALTH

General Provider Information

NPI Number	:	1942953484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHILOH RAE TAYLOR M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	6052 PEBBLE BEACH BLVD
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-3601
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6052 PEBBLE BEACH BLVD
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-3601
Country	:	US
Telephone Number	:	863-412-1611
Fax Number	:	847-730-2994

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

Provider Enumeration Date	:	02/03/2022
Last Update Date	:	02/03/2022

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Directions to “ SHILOH RAE TAYLOR M.S., CCC-SLP” Practice Location

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