Healthcare Provider Details

I. General information

NPI: 1740718337
Provider Name (Legal Business Name): SHELLIE YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

792 PLYMOUTH ST
BRIDGEWATER MA
02324-2752
US

IV. Provider business mailing address

4 YOUNGS LN
RAYNHAM MA
02767-1747
US

V. Phone/Fax

Practice location:
  • Phone: 508-807-4996
  • Fax:
Mailing address:
  • Phone: 508-837-3161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLABA10000521
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: