Healthcare Provider Details

I. General information

NPI: 1235984717
Provider Name (Legal Business Name): ALYCIA F YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6415 POWERS POINTE CIR FL 32810
ORLANDO FL
32818-1382
US

IV. Provider business mailing address

255 S ORANGE AVE STE 104
ORLANDO FL
32801-3411
US

V. Phone/Fax

Practice location:
  • Phone: 407-900-7832
  • Fax:
Mailing address:
  • Phone: 407-900-7832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: