MEDICARE: MR. VICTOR ZHIHUA SHI M.S. SP.ED.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist
2	251C00000X	Developmentally Disabled Services Day Training Agency	1260712	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	EGT82904946	OTHER	NY	EMPIRE/BLUE CROSS/BLUE SHIELD
2	EGT82904946	OTHER	NY	EMPIRE, BLUE CROSS / BLUE SHIELD
3	EGT82904946	OTHER	NY	EMPIRE-BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1699924753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VICTOR ZHIHUA SHI M.S. SP.ED.

Provider Business Mailing Address
First Line	:	6722 218TH ST
Second Line	:	APT. B
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-2609
Country	:	US
Telephone Number	:	917-586-4988
Fax Number	:	718-229-2825

Provider Business Practice Location Address
First Line	:	6722 218TH ST
Second Line	:	APT. B
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-2609
Country	:	US
Telephone Number	:	917-586-4988
Fax Number	:	718-229-2825

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2008
Last Update Date	:	10/12/2008

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