MEDICARE: SHATONDRICK YOUNG

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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1992458335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHATONDRICK YOUNG

Provider Business Mailing Address
First Line	:	1416 KINGSTON ST
Second Line	:
City	:	WOLFFORTH
State	:	TX
Zip	:	79382-1765
Country	:	US
Telephone Number	:	806-319-2204
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 38TH ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79412-1416
Country	:	US
Telephone Number	:	806-319-2204
Fax Number	:

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

Provider Enumeration Date	:	01/26/2022
Last Update Date	:	01/26/2022

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Directions to “ SHATONDRICK YOUNG ” Practice Location

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