Healthcare Provider Details

I. General information

NPI: 1235930827
Provider Name (Legal Business Name): SHARLENE KUO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3607 MANOR RD STE 101
AUSTIN TX
78723-5818
US

IV. Provider business mailing address

3607 MANOR RD STE 101
AUSTIN TX
78723-5818
US

V. Phone/Fax

Practice location:
  • Phone: 512-478-2273
  • Fax:
Mailing address:
  • Phone: 512-478-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18821
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: