Healthcare Provider Details

I. General information

NPI: 1669976064
Provider Name (Legal Business Name): SARAH SHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 W CHARLESTON BLVD STE 120
LAS VEGAS NV
89102-2352
US

IV. Provider business mailing address

1231 116TH AVE NE STE 950
BELLEVUE WA
98004-3832
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-2385
  • Fax:
Mailing address:
  • Phone: 425-454-3366
  • Fax: 425-646-5198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD61197695
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: