Provider Demographics
NPI:1679872550
Name:YANG-MIAO, SHELLY Y (RPH)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:Y
Last Name:YANG-MIAO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:Y
Other - Last Name:YANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:160 E 53RD ST
Mailing Address - Street 2:PHARMACY DEPT.
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5243
Mailing Address - Country:US
Mailing Address - Phone:212-610-0112
Mailing Address - Fax:
Practice Address - Street 1:160 E 53RD ST
Practice Address - Street 2:PHARMACY DEPT.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5243
Practice Address - Country:US
Practice Address - Phone:212-610-0112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist