Provider Demographics
NPI:1992121685
Name:SHANG, KE
Entity type:Individual
Prefix:
First Name:KE
Middle Name:
Last Name:SHANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 GREENPOINT AVE
Mailing Address - Street 2:4A
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-1707
Mailing Address - Country:US
Mailing Address - Phone:631-377-9622
Mailing Address - Fax:
Practice Address - Street 1:717 56TH ST
Practice Address - Street 2:AGI MEDICAL PLLC.
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3503
Practice Address - Country:US
Practice Address - Phone:631-377-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22 677665163W00000X
NY307175363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse