Healthcare Provider Details

I. General information

NPI: 1538214515
Provider Name (Legal Business Name): SHAUN D YOUNG PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 BLACKHAWK BLVD
MT PLEASANT UT
84647-2305
US

IV. Provider business mailing address

PO BOX 912042
ST GEORGE UT
84791-2042
US

V. Phone/Fax

Practice location:
  • Phone: 435-986-7156
  • Fax: 435-986-7160
Mailing address:
  • Phone: 435-215-0230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number13016451-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA18771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: