MEDICARE: STEPHANIE YOUNG-GRAVES MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator

General Provider Information

NPI Number	:	1205515673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE YOUNG-GRAVES MA

Provider Business Mailing Address
First Line	:	1909 E WASHINGTON LN
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19138-1229
Country	:	US
Telephone Number	:	215-549-5900
Fax Number	:	215-548-8886

Provider Business Practice Location Address
First Line	:	1909 E WASHINGTON LN
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19138-1229
Country	:	US
Telephone Number	:	215-549-5900
Fax Number	:	215-548-8886

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2023
Last Update Date	:	07/13/2023

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