Healthcare Provider Details

I. General information

NPI: 1871372979
Provider Name (Legal Business Name): TAYLOR MOO-YOUNG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 WADSWORTH DR
NORTH CHESTERFIELD VA
23236-4510
US

IV. Provider business mailing address

10992 INSPIRATION POINT PL
MANASSAS VA
20112-5863
US

V. Phone/Fax

Practice location:
  • Phone: 804-330-4021
  • Fax:
Mailing address:
  • Phone: 407-590-0396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: