Provider Demographics
NPI:1316124795
Name:SHI, XIANDONG (MD)
Entity type:Individual
Prefix:DR
First Name:XIANDONG
Middle Name:
Last Name:SHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41-60 MAIN STREET
Mailing Address - Street 2:SUIT 312
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-864-8648
Mailing Address - Fax:718-799-1019
Practice Address - Street 1:4160 MAIN ST UNIT 312
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3833
Practice Address - Country:US
Practice Address - Phone:718-865-8648
Practice Address - Fax:718-799-1019
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247287207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine