Provider Demographics
NPI:1679287387
Name:THORPE, JULIE SHAOWU (PA-C)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:SHAOWU
Last Name:THORPE
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 1:180 WATER ST APT 1204
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-5383
Mailing Address - Country:US
Mailing Address - Phone:774-230-8041
Mailing Address - Fax:
Practice Address - Street 1:2076 E 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3304
Practice Address - Country:US
Practice Address - Phone:877-208-2882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029202-01363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant