Provider Demographics
NPI:1154416410
Name:LIU-LEE, YINGXUE SHELLEY (MD)
Entity type:Individual
Prefix:DR
First Name:YINGXUE
Middle Name:SHELLEY
Last Name:LIU-LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:LIU-LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:557 CRANBURY RD
Mailing Address - Street 2:STE 7
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5419
Mailing Address - Country:US
Mailing Address - Phone:732-390-8780
Mailing Address - Fax:
Practice Address - Street 1:557 CRANBURY RD
Practice Address - Street 2:SUITE 18
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5419
Practice Address - Country:US
Practice Address - Phone:732-390-8780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07141200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8970009Medicaid