Healthcare Provider Details

I. General information

NPI: 1477946465
Provider Name (Legal Business Name): SHUJUN CAO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2015
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 55TH ST 1FL
BROOKLYN NY
11220-3263
US

IV. Provider business mailing address

50 S B B KING BLVD # 100
MEMPHIS TN
38103-2626
US

V. Phone/Fax

Practice location:
  • Phone: 718-972-6868
  • Fax:
Mailing address:
  • Phone: 901-436-1381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF339441
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: