Active NPI
Shari Madonna Youngblood, DCN
- Nutritionist
- Ellicott City, MD
National Provider Identifier
1396494563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- DX5551
- Practice address
- 3433 Jay Dr
Ellicott City, MD 21042-3635 - Phone
- (410) 446-2184
- NPI assigned
- Mar 23, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | DX5551 | MD | Primary |
Addresses
Primary practice location
3433 Jay Dr
Ellicott City, MD 21042-3635
Mailing address
3433 Jay Dr
Ellicott City, MD 21042-3635
Phone (410) 446-2184
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DX5551 | MD | MD | Nutritionist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Balance Point Wellness, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1647993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647993600000",
"number": "1396494563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3433 JAY DR",
"city": "ELLICOTT CITY",
"state": "MD",
"postal_code": "210423635",
"telephone_number": "410-446-2184"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3433 JAY DR",
"city": "ELLICOTT CITY",
"state": "MD",
"postal_code": "210423635",
"telephone_number": "410-446-2184"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNGBLOOD",
"first_name": "SHARI",
"middle_name": "MADONNA",
"name_prefix": "Dr.",
"credential": "DCN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-03-23",
"last_updated": "2022-03-23",
"certification_date": "2022-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "MD",
"license": "DX5551",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ellicott City, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.