Provider Demographics
NPI:1215654207
Name:LI, XUE YAO SHARON (MSN NP-BC, BSN RN)
Entity type:Individual
Prefix:
First Name:XUE YAO
Middle Name:SHARON
Last Name:LI
Suffix:
Gender:
Credentials:MSN NP-BC, BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 51ST AVE APT 3C
Mailing Address - Street 2:
Mailing Address - City:LONG IS CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5957
Mailing Address - Country:US
Mailing Address - Phone:646-204-1111
Mailing Address - Fax:
Practice Address - Street 1:2717 42ND RD APT 16C
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-4965
Practice Address - Country:US
Practice Address - Phone:646-204-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF421592-01363L00000X, 363L00000X
NYF355289-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherN/A