Individual
MR. CHARLES THADDIOUS TAYLOR JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
115 CHILI AVE, ROCHESTER, NY 14611-2604
(585) 351-1003
Mailing address
115 CHILI AVE, ROCHESTER, NY 14611-2604
(585) 351-1003
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
339455-01
NY
Other
Enumeration date
10/08/2020
Last updated
10/08/2020
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