Provider Demographics
NPI:1326844572
Name:YOUNG, RENETTA SHAVONNE
Entity type:Individual
Prefix:
First Name:RENETTA
Middle Name:SHAVONNE
Last Name:YOUNG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2006
Mailing Address - Country:US
Mailing Address - Phone:216-609-4826
Mailing Address - Fax:
Practice Address - Street 1:956 BEVERLY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44121-2006
Practice Address - Country:US
Practice Address - Phone:216-609-4826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker