Provider Demographics
NPI:1699360503
Name:YOUNG, MEYATA SHANTE
Entity Type:Individual
Prefix:
First Name:MEYATA
Middle Name:SHANTE
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 1:2704 BELLVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-1365
Mailing Address - Country:US
Mailing Address - Phone:185-034-1331
Mailing Address - Fax:
Practice Address - Street 1:2704 BELLVIEW AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32526-1365
Practice Address - Country:US
Practice Address - Phone:850-341-3315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR124322376K00000X
FL124322376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide