Provider Demographics
NPI:1497417257
Name:DOKTYCZ, TAYLOR
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:DOKTYCZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4691 DEVERON DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-6857
Mailing Address - Country:US
Mailing Address - Phone:860-281-2252
Mailing Address - Fax:336-203-2211
Practice Address - Street 1:4691 DEVERON DR
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-6857
Practice Address - Country:US
Practice Address - Phone:860-281-2252
Practice Address - Fax:336-203-2211
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT59.001659133V00000X
NCL008072133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered