Provider Demographics
NPI:1467197244
Name:YOUNG, SHANIA JOLI
Entity Type:Individual
Prefix:MISS
First Name:SHANIA
Middle Name:JOLI
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 GREAT EGRET LN
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-3513
Mailing Address - Country:US
Mailing Address - Phone:602-907-0198
Mailing Address - Fax:
Practice Address - Street 1:4224 GREAT EGRET LN
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-3513
Practice Address - Country:US
Practice Address - Phone:602-907-0198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician