Provider Demographics
NPI:1053873471
Name:TAQI, SHYLLA (DPM)
Entity type:Individual
Prefix:MS
First Name:SHYLLA
Middle Name:
Last Name:TAQI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12371 MACON DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2661
Mailing Address - Country:US
Mailing Address - Phone:909-730-7962
Mailing Address - Fax:
Practice Address - Street 1:4542 HAMMOCKS DR APT 306
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-7507
Practice Address - Country:US
Practice Address - Phone:909-730-7962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2023-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
PASC007359213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician