Healthcare Provider Details

I. General information

NPI: 1225698830
Provider Name (Legal Business Name): SIYUN XIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 S STATE ROAD 7
WELLINGTON FL
33414-6135
US

IV. Provider business mailing address

525 N WILTON PL APT 313
LOS ANGELES CA
90004-3850
US

V. Phone/Fax

Practice location:
  • Phone: 561-578-4582
  • Fax:
Mailing address:
  • Phone: 317-289-7602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA187221
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME175637
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number2026-02163
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: