Healthcare Provider Details

I. General information

NPI: 1851853832
Provider Name (Legal Business Name): KRISTA DIONNE YOUNG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 09/22/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6447 CERMARK RD
BERWYN IL
60402
US

IV. Provider business mailing address

1 HOSPITAL PLZ
STAMFORD CT
06902-3602
US

V. Phone/Fax

Practice location:
  • Phone: 773-254-1400
  • Fax:
Mailing address:
  • Phone: 203-276-7147
  • Fax: 203-276-7368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.161921
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: