Provider Demographics
NPI:1992721104
Name:SHI, SHELLY XIAOPING (MD)
Entity type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:XIAOPING
Last Name:SHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:185 CANAL ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4537
Mailing Address - Country:US
Mailing Address - Phone:917-388-2792
Mailing Address - Fax:
Practice Address - Street 1:185 CANAL ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4537
Practice Address - Country:US
Practice Address - Phone:917-388-2792
Practice Address - Fax:917-388-2715
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY221713207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02292928Medicaid
NYA300050402Medicare PIN
NY02292928Medicaid