Provider Demographics
NPI:1144584558
Name:MCCOY, SHAOBA RAY (SI)
Entity Type:Individual
Prefix:MR
First Name:SHAOBA
Middle Name:RAY
Last Name:MCCOY
Suffix:
Gender:M
Credentials:SI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 EASTERN PKWY APT 2D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-6353
Mailing Address - Country:US
Mailing Address - Phone:646-685-9070
Mailing Address - Fax:
Practice Address - Street 1:307 EASTERN PKWY APT 2D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-6353
Practice Address - Country:US
Practice Address - Phone:646-685-9070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist