Healthcare Provider Details

I. General information

NPI: 1922280775
Provider Name (Legal Business Name): SHIQI LIU LIC. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 BOSTON POST RD SUITE 30
SUDBURY MA
01776-3014
US

IV. Provider business mailing address

128 POWDER MILL RD
SUDBURY MA
01776-1055
US

V. Phone/Fax

Practice location:
  • Phone: 978-440-8805
  • Fax:
Mailing address:
  • Phone: 978-440-8805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number524
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: