Healthcare Provider Details

I. General information

NPI: 1124072962
Provider Name (Legal Business Name): SHARA L YOUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2318 MANATEE AVE W
BRADENTON FL
34205-5432
US

IV. Provider business mailing address

101 RIVERFRONT BLVD STE 710
BRADENTON FL
34205-8812
US

V. Phone/Fax

Practice location:
  • Phone: 941-714-7150
  • Fax:
Mailing address:
  • Phone: 941-776-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0430027
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME1245740
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: