Healthcare Provider Details

I. General information

NPI: 1326555798
Provider Name (Legal Business Name): SHUANG GAO MD, MS, MS, MSN, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRACE GAO MD, MS, MS, MSN, RD

II. Dates (important events)

Enumeration Date: 01/06/2018
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 LEITER RD
MIAMISBURG OH
45342-3600
US

IV. Provider business mailing address

2115 LEITER RD
MIAMISBURG OH
45342-3600
US

V. Phone/Fax

Practice location:
  • Phone: 937-384-6800
  • Fax: 937-384-6938
Mailing address:
  • Phone: 937-384-6800
  • Fax: 937-384-6938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.007133
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86068033
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: