Healthcare Provider Details

I. General information

NPI: 1902794894
Provider Name (Legal Business Name): BRANDON YEE TAO SHANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13781 NORTHERN BLVD # 2C
FLUSHING NY
11354-4320
US

IV. Provider business mailing address

13781 NORTHERN BLVD # 2C
FLUSHING NY
11354-4320
US

V. Phone/Fax

Practice location:
  • Phone: 929-362-2474
  • Fax: 929-362-2451
Mailing address:
  • Phone: 929-362-2474
  • Fax: 929-362-2451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: