Healthcare Provider Details

I. General information

NPI: 1962328492
Provider Name (Legal Business Name): SHUANGYU ZHAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 MAMARONECK AVE STE 150
WHITE PLAINS NY
10605-5222
US

IV. Provider business mailing address

225 BROADHOLLOW RD STE 402
MELVILLE NY
11747-4899
US

V. Phone/Fax

Practice location:
  • Phone: 914-328-2868
  • Fax:
Mailing address:
  • Phone: 631-385-7780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number005094
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: