Provider Demographics
NPI:1942036892
Name:YOUNG, SHAKIA LANANY
Entity type:Individual
Prefix:
First Name:SHAKIA
Middle Name:LANANY
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 1:17604 MAPLEBORO AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-2637
Mailing Address - Country:US
Mailing Address - Phone:216-396-4472
Mailing Address - Fax:
Practice Address - Street 1:17604 MAPLEBORO AVE
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-2637
Practice Address - Country:US
Practice Address - Phone:216-396-4472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician