Healthcare Provider Details

I. General information

NPI: 1699188078
Provider Name (Legal Business Name): ANDREA J. YOUNG NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 PARK AVE
VALLEY COTTAGE NY
10989-1812
US

IV. Provider business mailing address

3125 US ROUTE 9W
NEW WINDSOR NY
12553-6763
US

V. Phone/Fax

Practice location:
  • Phone: 561-635-1491
  • Fax:
Mailing address:
  • Phone: 914-502-3998
  • Fax: 518-708-6889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number404100
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number341820
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9196852
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number404100
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: