Healthcare Provider Details

I. General information

NPI: 1568165348
Provider Name (Legal Business Name): SHUNING LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 09/21/2025
Certification Date: 09/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MONROE ST
ENDICOTT NY
13760-5512
US

IV. Provider business mailing address

15357 HORACE HARDING EXPY
FLUSHING NY
11367-1246
US

V. Phone/Fax

Practice location:
  • Phone: 607-953-4445
  • Fax:
Mailing address:
  • Phone: 917-932-5359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number065128
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: