Healthcare Provider Details

I. General information

NPI: 1427201441
Provider Name (Legal Business Name): DAVID SHUAI-WEI SHI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 07/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56-45 MAIN STREET DEPT. OF ANESTHESIOLOGY
FLUSHING NY
11355
US

IV. Provider business mailing address

718 TEANECK RD DEPARTMENT OF ANESTHESIOLOGY
TEANECK NJ
07666
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-2597
  • Fax:
Mailing address:
  • Phone: 201-833-7149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number268142
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number268142
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA10382700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: