Healthcare Provider Details

I. General information

NPI: 1073449450
Provider Name (Legal Business Name): CASSIDY MAY YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 LUMBER AVE STE 6
WHEELING WV
26003-5350
US

IV. Provider business mailing address

9 LAURELWOOD ST
WHEELING WV
26003-9717
US

V. Phone/Fax

Practice location:
  • Phone: 304-780-6958
  • Fax:
Mailing address:
  • Phone: 304-312-4264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number108602
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: