Provider Demographics
NPI:1003175209
Name:HO, SHU FAN LORA
Entity Type:Individual
Prefix:MS
First Name:SHU FAN LORA
Middle Name:
Last Name:HO
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 1:9409 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2222
Mailing Address - Country:US
Mailing Address - Phone:718-846-9821
Mailing Address - Fax:718-846-9527
Practice Address - Street 1:9409 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2222
Practice Address - Country:US
Practice Address - Phone:718-846-9821
Practice Address - Fax:718-846-9527
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator