Provider Demographics
NPI:1154155331
Name:XU, SHIFANG (MFT-LP)
Entity type:Individual
Prefix:
First Name:SHIFANG
Middle Name:
Last Name:XU
Suffix:
Gender:F
Credentials:MFT-LP
Other - Prefix:
Other - First Name:WINNIE
Other - Middle Name:
Other - Last Name:XU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT-LP
Mailing Address - Street 1:394 WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4228
Mailing Address - Country:US
Mailing Address - Phone:516-205-1121
Mailing Address - Fax:
Practice Address - Street 1:1 RABRO DR STE 10
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4270
Practice Address - Country:US
Practice Address - Phone:516-205-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP130585106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist