Provider Demographics
NPI:1487802666
Name:TAN, SHAO YUE (MD)
Entity type:Individual
Prefix:
First Name:SHAO YUE
Middle Name:
Last Name:TAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5314 7TH AVE
Mailing Address - Street 2:1FL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2546
Mailing Address - Country:US
Mailing Address - Phone:917-257-6194
Mailing Address - Fax:718-686-6887
Practice Address - Street 1:5314 7TH AVE
Practice Address - Street 2:1FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2546
Practice Address - Country:US
Practice Address - Phone:718-686-6888
Practice Address - Fax:718-686-6887
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-31
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY250021-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine