Provider Demographics
NPI:1649908005
Name:YOUNG, KRISHYON (IBCLC)
Entity type:Individual
Prefix:
First Name:KRISHYON
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 OLDHAM ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-2524
Mailing Address - Country:US
Mailing Address - Phone:781-964-5626
Mailing Address - Fax:
Practice Address - Street 1:68 OLDHAM ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-2524
Practice Address - Country:US
Practice Address - Phone:781-964-5626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11261374J00000X
MAL-307119174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula