Healthcare Provider Details

I. General information

NPI: 1588587745
Provider Name (Legal Business Name): SHANG LYU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 DEFENSE HWY STE 12
CROFTON MD
21114-2430
US

IV. Provider business mailing address

2135 DEFENSE HWY STE 12
CROFTON MD
21114-2430
US

V. Phone/Fax

Practice location:
  • Phone: 443-285-1760
  • Fax:
Mailing address:
  • Phone: 443-285-1760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU03332
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: