Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 945 | ND |
Y | 225X00000X | Occupational Therapist | 0286 | SD |
NPI | 1003880402 |
---|---|
Provider Name | Shannon M Young |
First Address | Aberdeen, SD 57402-4400 |
Second Address | Aberdeen, SD 57401-4527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 02/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26336 | BLUE SHIELD (01) | ND |
50997 | (05) | ND |
CG3429 | RAILROAD MEDICARE (01) | ND |