Healthcare Provider Details

I. General information

NPI: 1215626783
Provider Name (Legal Business Name): SHARIEKA R YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2541 WALDEN GLEN CIR
CINCINNATI OH
45231-1405
US

IV. Provider business mailing address

2541 WALDEN GLEN CIR
CINCINNATI OH
45231-1405
US

V. Phone/Fax

Practice location:
  • Phone: 513-543-5646
  • Fax:
Mailing address:
  • Phone: 513-543-5646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number602627900323
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: