Provider Demographics
NPI:1619317906
Name:YOUNG, ROBERT
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STNA
Mailing Address - Street 1:6805 MAYFIELD RD
Mailing Address - Street 2:APT 405B
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2272
Mailing Address - Country:US
Mailing Address - Phone:216-491-8620
Mailing Address - Fax:
Practice Address - Street 1:6805 MAYFIELD RD
Practice Address - Street 2:APT 405B
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2272
Practice Address - Country:US
Practice Address - Phone:216-491-8620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400778670708376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide