Healthcare Provider Details

I. General information

NPI: 1699947499
Provider Name (Legal Business Name): MICHELLE YAO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 N BROADWAY STE LE1
JERICHO NY
11753-2000
US

IV. Provider business mailing address

366 N BROADWAY STE LE1
JERICHO NY
11753-2000
US

V. Phone/Fax

Practice location:
  • Phone: 516-715-3511
  • Fax: 516-715-3511
Mailing address:
  • Phone: 516-715-3511
  • Fax: 516-715-3511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number252006
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: