Healthcare Provider Details

I. General information

NPI: 1396530291
Provider Name (Legal Business Name): MADELYN YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6480 HARRISON AVE
CINCINNATI OH
45247-7961
US

IV. Provider business mailing address

507 MONTVIEW CT
CINCINNATI OH
45238-4618
US

V. Phone/Fax

Practice location:
  • Phone: 513-354-3700
  • Fax: 513-354-7651
Mailing address:
  • Phone: 513-827-1501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.010335RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: