Healthcare Provider Details

I. General information

NPI: 1336644590
Provider Name (Legal Business Name): SHUO SHAWN LIU MD; PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 NW 17TH AVE
DELRAY BEACH FL
33445-2578
US

IV. Provider business mailing address

18360 CORAL CHASE DR
BOCA RATON FL
33498-1969
US

V. Phone/Fax

Practice location:
  • Phone: 773-816-4522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberME162013
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: