Provider Demographics
NPI:1487895421
Name:YAO, SUELLAN GO (DMD)
Entity type:Individual
Prefix:
First Name:SUELLAN
Middle Name:GO
Last Name:YAO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E 37TH ST APT 9F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3054
Mailing Address - Country:US
Mailing Address - Phone:212-213-8308
Mailing Address - Fax:
Practice Address - Street 1:115 E 61ST ST STE 8D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8185
Practice Address - Country:US
Practice Address - Phone:212-319-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-22
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0529471223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics