Provider Demographics
NPI:1073259016
Name:YOUNG, NDEA SHUNYAI
Entity type:Individual
Prefix:
First Name:NDEA
Middle Name:SHUNYAI
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 1:857 E BELLEVIEW ST APT 203
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-4582
Mailing Address - Country:US
Mailing Address - Phone:612-453-6869
Mailing Address - Fax:
Practice Address - Street 1:857 E BELLEVIEW ST APT 203
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-4582
Practice Address - Country:US
Practice Address - Phone:612-453-6869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker