Provider Demographics
NPI:1538419197
Name:TAYLOR, SHARON
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:TAYLOR
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 1:2120 LIKENS LN STE 104
Mailing Address - Street 2:
Mailing Address - City:FARRELL
Mailing Address - State:PA
Mailing Address - Zip Code:16121-2304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2120 LIKENS LN STE 104
Practice Address - Street 2:
Practice Address - City:FARRELL
Practice Address - State:PA
Practice Address - Zip Code:16121-2304
Practice Address - Country:US
Practice Address - Phone:724-981-6810
Practice Address - Fax:724-981-5617
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055807363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA153419197Medicaid