Provider Demographics
NPI:1124074000
Name:WADE, SHENG (PA)
Entity type:Individual
Prefix:MS
First Name:SHENG
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:13839 JEWEL AVE
Mailing Address - Street 2:APT#1D
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1997
Mailing Address - Country:US
Mailing Address - Phone:718-501-8180
Mailing Address - Fax:212-238-7009
Practice Address - Street 1:227 MADISON ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-7537
Practice Address - Country:US
Practice Address - Phone:212-238-7614
Practice Address - Fax:212-238-7009
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY004027363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP74819Medicare UPIN