Provider Demographics
NPI:1396494563
Name:YOUNGBLOOD, SHARI MADONNA (DCN)
Entity type:Individual
Prefix:DR
First Name:SHARI
Middle Name:MADONNA
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:DCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 JAY DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-3635
Mailing Address - Country:US
Mailing Address - Phone:410-446-2184
Mailing Address - Fax:
Practice Address - Street 1:3433 JAY DR
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-3635
Practice Address - Country:US
Practice Address - Phone:410-446-2184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5551133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist