Provider Demographics
NPI:1649779505
Name:YOUNG, MELONDY
Entity Type:Individual
Prefix:
First Name:MELONDY
Middle Name:
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 1:3620 TREMONT DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-3059
Mailing Address - Country:US
Mailing Address - Phone:314-766-8095
Mailing Address - Fax:
Practice Address - Street 1:3620 TREMONT DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-3059
Practice Address - Country:US
Practice Address - Phone:314-766-8095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No374U00000XNursing Service Related ProvidersHome Health Aide