Provider Demographics
NPI:1548802275
Name:LUGO, SHELLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:LUGO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9033 ELMHURST AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7935
Mailing Address - Country:US
Mailing Address - Phone:718-457-7000
Mailing Address - Fax:718-899-4955
Practice Address - Street 1:9033 ELMHURST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7935
Practice Address - Country:US
Practice Address - Phone:718-457-7000
Practice Address - Fax:718-899-4955
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029491207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine