Healthcare Provider Details

I. General information

NPI: 1245166453
Provider Name (Legal Business Name): SHIHO HEALTH SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8414 13TH AVE
BROOKLYN NY
11228-3336
US

IV. Provider business mailing address

8639 16TH AVE
BROOKLYN NY
11214-3611
US

V. Phone/Fax

Practice location:
  • Phone: 718-921-2329
  • Fax:
Mailing address:
  • Phone: 347-661-6015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT MCCALLEN M BRACKBILL
Title or Position: VICE-PRESIDENT
Credential: PHD
Phone: 347-661-6015