Provider Demographics
NPI:1063603058
Name:LI, SHUNYU (LAC)
Entity type:Individual
Prefix:MR
First Name:SHUNYU
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 RACEBROOK RD STE 237-238
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3103
Mailing Address - Country:US
Mailing Address - Phone:203-507-1454
Mailing Address - Fax:
Practice Address - Street 1:284 RACEBROOK RD STE 237-238
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3103
Practice Address - Country:US
Practice Address - Phone:203-507-1454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000363171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist