Provider Demographics
NPI:1700331733
Name:DERRIS, TAYLOR SKY (MS CFY SLP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:SKY
Last Name:DERRIS
Suffix:
Gender:F
Credentials:MS CFY SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S BISCAYNE BLVD
Mailing Address - Street 2:APARTMENT 3916
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2306
Mailing Address - Country:US
Mailing Address - Phone:732-567-7387
Mailing Address - Fax:
Practice Address - Street 1:11025 SW 84TH ST
Practice Address - Street 2:COTTAGE 8
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3857
Practice Address - Country:US
Practice Address - Phone:732-567-7387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2016-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 7664235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist