Healthcare Provider Details

I. General information

NPI: 1548367428
Provider Name (Legal Business Name): LASHAWNDA MICHELLE YOUNG PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

4000 NW 51ST ST #L220
GAINESVILLE FL
32606-4333
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1611
  • Fax: 352-379-4015
Mailing address:
  • Phone: 352-377-8304
  • Fax: 352-379-4015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9102430
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: