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General NPI Number Information
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NPI Number | 1033923917
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Entity Type | Individual
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Provider Name | MRS. AJA SHARDAI YOUNG
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Gender | Female
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 3939 US HIGHWAY 80 E STE 223
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City | MESQUITE
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State | TX
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Zip | 75150-3353
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Country | US
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Telephone | 682-360-9272
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Fax |
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Provider Business Mailing Address
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Address Line | 308 SONATA ST
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City | WAXAHACHIE
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State | TX
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Zip | 75165-3809
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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