Healthcare Provider Details

I. General information

NPI: 1790277051
Provider Name (Legal Business Name): YINING SHAO MD, PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2018
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE
BRONX NY
10457
US

IV. Provider business mailing address

10 AMSTERDAM AVE APT 603
NEW YORK NY
10023-7490
US

V. Phone/Fax

Practice location:
  • Phone: 718-590-1800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number321018
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: