Provider Demographics
NPI:1932171865
Name:YOUNG, SHERICE
Entity Type:Individual
Prefix:
First Name:SHERICE
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 1:4372 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:KANE
Mailing Address - State:PA
Mailing Address - Zip Code:16735-3060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4372 ROUTE 6
Practice Address - Street 2:
Practice Address - City:KANE
Practice Address - State:PA
Practice Address - Zip Code:16735-3060
Practice Address - Country:US
Practice Address - Phone:814-837-4741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-04
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428095207V00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
016641OtherHIGHMARK BLUE SHIELD
8237768OtherCIGNA HEALTH CARE
PA2646208000OtherINDEPENDENCE BLUE CROSS
PA30051169OtherKEYSTONE MERCY
PA7183757OtherAETNA
PAMD428095OtherPA LICENSE NUMBER
PA1811057OtherHIGHMARK BLUE SHIELD
PA262520449OtherTIN
PA1015475490001Medicaid
PAMD428095OtherPA LICENSE NUMBER
PA30051169OtherKEYSTONE MERCY