Healthcare Provider Details

I. General information

NPI: 1386561124
Provider Name (Legal Business Name): KAILEE YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5571 4TH ST N
ST PETERSBURG FL
33703-2251
US

IV. Provider business mailing address

101 N MERIDIAN AVE UNIT 1230
TAMPA FL
33602-3990
US

V. Phone/Fax

Practice location:
  • Phone: 727-525-7852
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAPRN11048050
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: