Healthcare Provider Details

I. General information

NPI: 1053926634
Provider Name (Legal Business Name): SALLY CAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61-43 186TH STREET
FRESH MEADOWS NY
11365
US

IV. Provider business mailing address

216 BAY 35TH ST
BROOKLYN NY
11214-5470
US

V. Phone/Fax

Practice location:
  • Phone: 929-200-7105
  • Fax:
Mailing address:
  • Phone: 718-801-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: