Healthcare Provider Details

I. General information

NPI: 1053626440
Provider Name (Legal Business Name): SHERRYLYN YOUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 E WHITEHOUSE CANYON RD STE 110
GREEN VALLEY AZ
85614-0538
US

IV. Provider business mailing address

5055 E BROADWAY BLVD STE A-100
TUCSON AZ
85711-3640
US

V. Phone/Fax

Practice location:
  • Phone: 520-547-7047
  • Fax: 520-625-9162
Mailing address:
  • Phone: 520-327-0460
  • Fax: 520-795-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number1981
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: