Healthcare Provider Details

I. General information

NPI: 1649354036
Provider Name (Legal Business Name): SUSAN YOU SHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 ROCKAWAY PKWY
BROOKLYN NY
11236-2339
US

IV. Provider business mailing address

1340 ROCKAWAY PKWY
BROOKLYN NY
11236-2339
US

V. Phone/Fax

Practice location:
  • Phone: 718-257-4333
  • Fax: 718-257-2121
Mailing address:
  • Phone: 718-257-4333
  • Fax: 718-257-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number221715
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: