Provider Demographics
NPI:1861087884
Name:AO, SHYANG SHUOH (PA-C)
Entity type:Individual
Prefix:
First Name:SHYANG SHUOH
Middle Name:
Last Name:AO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LENA
Other - Middle Name:
Other - Last Name:AO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:19507 KILFINAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4003
Mailing Address - Country:US
Mailing Address - Phone:818-626-6387
Mailing Address - Fax:
Practice Address - Street 1:19507 KILFINAN ST
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-4003
Practice Address - Country:US
Practice Address - Phone:818-626-6387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant