MEDICARE: IRENE SHAO PA-C

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	363A00000X	Physician Assistant	5601014014	MI

General Provider Information

NPI Number	:	1689411837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE SHAO PA-C

Provider Business Mailing Address
First Line	:	24 FRANK LLOYD WRIGHT DR # J2000
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-9484
Country	:	US
Telephone Number	:	734-747-6766
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 S CANTON CENTER RD
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-1992
Country	:	US
Telephone Number	:	734-844-8743
Fax Number	:	734-844-8744

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

Provider Enumeration Date	:	07/13/2024
Last Update Date	:	06/04/2026

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Directions to “ IRENE SHAO PA-C” Practice Location

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