Healthcare Provider Details

I. General information

NPI: 1508237595
Provider Name (Legal Business Name): SHANTELLE YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2015
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR # 120
OXNARD CA
93036-2612
US

IV. Provider business mailing address

1911 WILLIAMS DR # 120
OXNARD CA
93036-2612
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-9274
  • Fax: 805-981-9271
Mailing address:
  • Phone: 805-981-9274
  • Fax: 805-981-9271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: