Healthcare Provider Details

I. General information

NPI: 1861067654
Provider Name (Legal Business Name): SHARDAY TIERRIA YOUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2623 E SLAUSON AVE
HUNTINGTON PARK CA
90255-2926
US

IV. Provider business mailing address

2623 E SLAUSON AVE
HUNTINGTON PARK CA
90255-2926
US

V. Phone/Fax

Practice location:
  • Phone: 323-583-1931
  • Fax:
Mailing address:
  • Phone: 910-337-5022
  • Fax: 323-583-1931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA203425
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: