Provider Demographics
NPI:1962236422
Name:TANG, SHIYU
Entity type:Individual
Prefix:
First Name:SHIYU
Middle Name:
Last Name:TANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S JOYCE ST APT 304
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-1877
Mailing Address - Country:US
Mailing Address - Phone:703-216-1702
Mailing Address - Fax:
Practice Address - Street 1:1201 SEVEN LOCKS RD STE 360-77
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20854-2931
Practice Address - Country:US
Practice Address - Phone:240-810-3790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14248101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health