Individual provider Active NPI

Sylvia Lysandra Young, NP

  • Family Nurse Practitioner
  • Pueblo, CO
National Provider Identifier
1265667190
Registry record updated Jun 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5964 Issued in CO
Practice address
902 Lakeview Ave
Pueblo, CO 81004-3597
Phone
(719) 557-5855
Fax
(719) 557-5097
NPI assigned
May 21, 2009
Last updated
Jun 26, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 5964 CO
Family Nurse Practitioner 363LF0000X 5964 CO Primary

Addresses

Primary practice location

902 Lakeview Ave
Pueblo, CO 81004-3597

Mailing address

902 Lakeview Ave
Pueblo, CO 81004-3597
Phone (719) 557-5855

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, DC, MS, MD4 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20180322000746 FL Practitioner - Nurse Practitioner 9931378098 Reassigns benefits to 1 organization
I20240106000432 DC Practitioner - Nurse Practitioner 9931378098
I20250519001516 MS Practitioner - Nurse Practitioner 9931378098 Reassigns benefits to 1 organization
I20260108000093 MD Practitioner - Nurse Practitioner 9931378098 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PSP Medical Clinic LLCGroup PAC ID 6406859446, 11 clinicians
Health Partners, Inc.Group PAC ID 1355629148, 2 clinicians

Practice addresses (Care Compare)

1171 Hart St
Canton, MS 39046-4805
Phone (601) 859-9888

3070 Crain Hwy
Suite 101
Waldorf, MD 20601-2831
Phone (301) 645-3556

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5964COMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
PSP Medical Clinic CurrentSince May 1, 2025 Accepting new patients
PSP Medical Clinic LLC Current Accepting new patients
Health Partners, Inc. CurrentSince Jan 1, 2026 Accepting new patients
Infinite Medical PC CurrentSince Feb 16, 2022 Accepting new patients

Locations

220 Sierra Dr
North Miami Beach, FL 33179
Phone (305) 653-8427

4375 Port Tobacco Rd
Nanjemoy, MD 20662
Phone (301) 645-3556

3070 Crain Hwy
Ste 101
Waldorf, MD 20601
Phone (301) 645-3556

1171 Hart St
Canton, MS 39046
Phone (601) 859-9888

2629 Courthouse Cir
Flowood, MS 39232
Phone (601) 362-0611

1435 Grand Ave
Yazoo City, MS 39194
Phone (662) 532-2399

250 Skillman St
Ste 202
Brooklyn, NY 11205

Interoperability endpoints

  • Direct secure messaging: sylvia.young.p1@direct.magnoliamedical.nextgenshare.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403740800000",
    "number": "1265667190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 LAKEVIEW AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043597",
            "telephone_number": "719-557-5855",
            "fax_number": "719-557-5097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 LAKEVIEW AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043597",
            "telephone_number": "719-557-5855",
            "fax_number": "719-557-5097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "SYLVIA",
        "middle_name": "LYSANDRA",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-21",
        "last_updated": "2014-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "CO",
            "license": "5964",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "5964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.