Provider Demographics
NPI:1598768517
Name:YOUNG, SHARON ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ANN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4226 Y ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2149
Mailing Address - Country:US
Mailing Address - Phone:916-454-5614
Mailing Address - Fax:760-348-6032
Practice Address - Street 1:7018 BLAIR RD
Practice Address - Street 2:
Practice Address - City:CALIPATRIA
Practice Address - State:CA
Practice Address - Zip Code:92233-9633
Practice Address - Country:US
Practice Address - Phone:760-348-7000
Practice Address - Fax:760-348-6032
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16374363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA16374Medicaid
CAP31965Medicare UPIN
CA0PA163741Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER