Healthcare Provider Details

I. General information

NPI: 1265699540
Provider Name (Legal Business Name): XIAOYUN SHANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 BARATARIA BLVD
MARRERO LA
70072
US

IV. Provider business mailing address

5422 CLARA ST
NEW ORLEANS LA
70115-7003
US

V. Phone/Fax

Practice location:
  • Phone: 504-368-7337
  • Fax: 504-368-7376
Mailing address:
  • Phone: 617-959-2634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number303739
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: