Healthcare Provider Details

I. General information

NPI: 1295784601
Provider Name (Legal Business Name): MARIA SIOBHANNE YOUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4256 FULTON DR NW APT A
CANTON OH
44718-2879
US

IV. Provider business mailing address

4256 FULTON DR NW APT A
CANTON OH
44718-2879
US

V. Phone/Fax

Practice location:
  • Phone: 330-754-6696
  • Fax: 330-754-6825
Mailing address:
  • Phone: 330-754-6696
  • Fax: 330-754-6825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35090762
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: