Healthcare Provider Details

I. General information

NPI: 1568389823
Provider Name (Legal Business Name): SHIYANG XU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7727 LAKE UNDERHILL RD
ORLANDO FL
32822-8224
US

IV. Provider business mailing address

125 E PINE ST APT 1617
ORLANDO FL
32801-3086
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-6413
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberTRN46581
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: