MEDICARE: SHAQUIL YOUNG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		OH

General Provider Information

NPI Number	:	1285320085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAQUIL YOUNG

Provider Business Mailing Address
First Line	:	PO BOX 201201
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-8103
Country	:	US
Telephone Number	:	216-553-9394
Fax Number	:

Provider Business Practice Location Address
First Line	:	1071 RUSHLEIGH RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44121-1445
Country	:	US
Telephone Number	:	216-553-9394
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2023
Last Update Date	:	04/13/2023

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Directions to “ SHAQUIL YOUNG ” Practice Location

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