Provider Demographics
NPI:1063286920
Name:SHA, YANGLIN (MASTER DEGREE, LAC)
Entity type:Individual
Prefix:
First Name:YANGLIN
Middle Name:
Last Name:SHA
Suffix:
Gender:M
Credentials:MASTER DEGREE, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14935 NORTHERN BLVD APT 5B
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3865
Mailing Address - Country:US
Mailing Address - Phone:929-228-8265
Mailing Address - Fax:
Practice Address - Street 1:14935 NORTHERN BLVD APT 5B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3865
Practice Address - Country:US
Practice Address - Phone:929-228-8265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007409171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist