Provider Demographics
NPI:1417688037
Name:YOUNG, TAYLOR ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ELIZABETH
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:61 DELANO ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:NY
Mailing Address - Zip Code:13142-1400
Mailing Address - Country:US
Mailing Address - Phone:315-298-6564
Mailing Address - Fax:315-298-7831
Practice Address - Street 1:510 S 4TH ST STE 600
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-2952
Practice Address - Country:US
Practice Address - Phone:315-598-4790
Practice Address - Fax:315-593-6195
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X, 363AM0700X
NY030951363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program