Healthcare Provider Details

I. General information

NPI: 1689510901
Provider Name (Legal Business Name): SHAWNTRICE YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3518 N 54TH ST
OMAHA NE
68104-3516
US

IV. Provider business mailing address

3518 N 54TH ST
OMAHA NE
68104-3516
US

V. Phone/Fax

Practice location:
  • Phone: 402-812-6115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: