Provider Demographics
NPI:1265795173
Name:TAYLOR, JESSICA SHANE
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:SHANE
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 1:3255 BRIGHTON HENRIETTA TOWN LINE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-2806
Mailing Address - Country:US
Mailing Address - Phone:585-427-7610
Mailing Address - Fax:
Practice Address - Street 1:3255 BRIGHTON HENRIETTA TOWN LINE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2806
Practice Address - Country:US
Practice Address - Phone:585-427-7610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist