Healthcare Provider Details

I. General information

NPI: 1356837009
Provider Name (Legal Business Name): SHU CAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NORTHERN BLVD STE 260
GREAT NECK NY
11021-5341
US

IV. Provider business mailing address

1000 NORTHERN BLVD STE 260
GREAT NECK NY
11021-5341
US

V. Phone/Fax

Practice location:
  • Phone: 516-928-6512
  • Fax:
Mailing address:
  • Phone: 516-928-6512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number335483
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: