Healthcare Provider Details

I. General information

NPI: 1205515673
Provider Name (Legal Business Name): STEPHANIE YOUNG-GRAVES MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 E WASHINGTON LN
PHILADELPHIA PA
19138-1229
US

IV. Provider business mailing address

1909 E WASHINGTON LN
PHILADELPHIA PA
19138-1229
US

V. Phone/Fax

Practice location:
  • Phone: 215-549-5900
  • Fax: 215-548-8886
Mailing address:
  • Phone: 215-549-5900
  • Fax: 215-548-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: