Healthcare Provider Details

I. General information

NPI: 1407742638
Provider Name (Legal Business Name): MS. DAWNSHERRIE K YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15475 ANNAPOLIS RD STE 40
BOWIE MD
20715-3049
US

IV. Provider business mailing address

9113 ELDON DR
CLINTON MD
20735-2941
US

V. Phone/Fax

Practice location:
  • Phone: 240-530-0095
  • Fax:
Mailing address:
  • Phone: 240-530-0095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberVKVCDMNL5A
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberVKVCDMNL5A
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberVKVCDMNL5A
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: