Individual
SHELLY TAYLOR-SOETAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1894 WALTON AVE, BRONX, NY 10453-6018
(718) 583-2700
Mailing address
1894 WALTON AVE, BRONX, NY 10453-6018
(718) 583-2700
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN1858222
MA
1223G0001X
General Practice Dentistry
DN 22291
FL
1223P0300X
Periodontics
Primary
062433-01
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/10/2016
Last updated
10/09/2025
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