Healthcare Provider Details

I. General information

NPI: 1235699372
Provider Name (Legal Business Name): YING SHAO DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 NORTHWESTERN DR STE 300
BLOOMFIELD CT
06002-6401
US

IV. Provider business mailing address

1290 SILAS DEANE HWY HHC CVO
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 860-547-0616
  • Fax: 860-524-2655
Mailing address:
  • Phone: 860-972-5507
  • Fax: 860-972-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN007255
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1205
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: