Provider Demographics
NPI:1679049324
Name:SEHORN, TAYLOR MICHELLE
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:MICHELLE
Last Name:SEHORN
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 1:3150 E BEARDSLEY RD UNIT 1017
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-3561
Mailing Address - Country:US
Mailing Address - Phone:480-862-4417
Mailing Address - Fax:
Practice Address - Street 1:20950 N TATUM BLVD STE 190
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4251
Practice Address - Country:US
Practice Address - Phone:480-776-0021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-21
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program