Healthcare Provider Details

I. General information

NPI: 1306442512
Provider Name (Legal Business Name): SHIRLEY GAO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E 233RD ST
BRONX NY
10466-2604
US

IV. Provider business mailing address

161 LENOX AVE
NEW YORK NY
10026-1320
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number026299
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: