Individual provider Active NPI

Shirley Mo, MD

  • Pediatrics Physician
  • Flushing, NY
National Provider Identifier
1265006704
Registry record updated Oct 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
328904 Issued in NY
Practice address
13626 37TH Ave
Flushing, NY 11354-6533
Phone
(718) 886-1222
Fax
(718) 886-3903
NPI assigned
May 19, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 328904 NY Primary

Addresses

Primary practice location

13626 37TH Ave
Flushing, NY 11354-6533

Mailing address

125 Walker St
New York, NY 10013-4135
Phone (212) 226-8866

Other identifiers 1

IdentifierTypeStateIssuer
07894246MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260107003630 NY Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 9032518287

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Charles B. Wang Community Health Center, Inc. Past Accepting new patients

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722

Interoperability endpoints

  • Direct secure messaging: smo787915@direct.ochin.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761696000000",
    "number": "1265006704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 WALKER ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100134135",
            "telephone_number": "212-226-8866",
            "fax_number": "212-226-2289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13626 37TH AVE",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113546533",
            "telephone_number": "718-886-1222",
            "fax_number": "718-886-3903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MO",
        "first_name": "SHIRLEY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-19",
        "last_updated": "2025-10-29",
        "certification_date": "2025-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "328904",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07894246",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

Verify at the official NPI Registry.