Healthcare Provider Details

I. General information

NPI: 1699457028
Provider Name (Legal Business Name): SYDNEY MCKENNA YOUNG PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 OLENTANGY RIVER RD
COLUMBUS OH
43214-3908
US

IV. Provider business mailing address

7516 OAK HILL DR
CHESTERLAND OH
44026-1725
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-5000
  • Fax:
Mailing address:
  • Phone: 440-321-5429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.008382RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: