Provider Demographics
NPI:1699924753
Name:SHI, VICTOR ZHIHUA (MS SPED)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:ZHIHUA
Last Name:SHI
Suffix:
Gender:M
Credentials:MS SPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6722 218TH ST
Mailing Address - Street 2:APT. B
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2609
Mailing Address - Country:US
Mailing Address - Phone:917-586-4988
Mailing Address - Fax:718-229-2825
Practice Address - Street 1:6722 218TH ST
Practice Address - Street 2:APT. B
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2609
Practice Address - Country:US
Practice Address - Phone:917-586-4988
Practice Address - Fax:718-229-2825
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-14
Last Update Date:2008-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY1260712251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYEGT82904946OtherEMPIRE/BLUE CROSS/BLUE SHIELD
NYEGT82904946OtherEMPIRE, BLUE CROSS / BLUE SHIELD
NYEGT82904946OtherEMPIRE-BLUE CROSS/BLUE SHIELD