Provider Demographics
NPI:1053889311
Name:TAYLOR, MELISSA LYNN
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
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 1:6700 WASHINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3405
Mailing Address - Country:US
Mailing Address - Phone:830-275-4216
Mailing Address - Fax:
Practice Address - Street 1:103 INDIAN ROCKS RD S
Practice Address - Street 2:
Practice Address - City:BELLEAIR BLUFFS
Practice Address - State:FL
Practice Address - Zip Code:33770-4018
Practice Address - Country:US
Practice Address - Phone:727-315-0777
Practice Address - Fax:727-315-0777
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL237600000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter