Provider Demographics
NPI:1538214515
Name:YOUNG, SHAUN D (PA)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:D
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 912042
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84791-2042
Mailing Address - Country:US
Mailing Address - Phone:435-215-0230
Mailing Address - Fax:
Practice Address - Street 1:1125 BLACKHAWK BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:UT
Practice Address - Zip Code:84647-2305
Practice Address - Country:US
Practice Address - Phone:435-986-7156
Practice Address - Fax:435-986-7160
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18771363AS0400X
UT13016451-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
W17163OtherMEDICARE GROUP NUMBER
WPA18771AOtherMEDICARE PROVIDER ID
W17163OtherMEDICARE PTAN