MEDICARE: SHAO YUE TAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	250021-1	NY

General Provider Information

NPI Number	:	1487802666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAO YUE TAN M.D.

Provider Business Mailing Address
First Line	:	5314 7TH AVE
Second Line	:	1FL
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2546
Country	:	US
Telephone Number	:	917-257-6194
Fax Number	:	718-686-6887

Provider Business Practice Location Address
First Line	:	5314 7TH AVE
Second Line	:	1FL
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2546
Country	:	US
Telephone Number	:	718-686-6888
Fax Number	:	718-686-6887

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2008
Last Update Date	:	05/19/2026

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Directions to “ SHAO YUE TAN M.D.” Practice Location

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