Provider Demographics
NPI:1295330769
Name:SANSEVERO, TAYLOR MARIE (DNP, APRN, CPNP)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:MARIE
Last Name:SANSEVERO
Suffix:
Gender:F
Credentials:DNP, APRN, CPNP
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:MARIE
Other - Last Name:JENDRAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 SAYBROOK RD STE 1
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426-1190
Mailing Address - Country:US
Mailing Address - Phone:860-767-0168
Mailing Address - Fax:
Practice Address - Street 1:35 SAYBROOK RD STE 1
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1190
Practice Address - Country:US
Practice Address - Phone:860-767-0168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9028363LP0200X
MA2343297363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics