Provider Demographics
NPI:1588378681
Name:SHANSHAN RAO INCOPORATED
Entity type:Organization
Organization Name:SHANSHAN RAO INCOPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL INSTRUCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANSHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:551-999-1136
Mailing Address - Street 1:18 FINGERBOARD RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3806
Mailing Address - Country:US
Mailing Address - Phone:551-999-1136
Mailing Address - Fax:
Practice Address - Street 1:18 FINGERBOARD RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3806
Practice Address - Country:US
Practice Address - Phone:551-999-1136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1053858985Medicaid