Healthcare Provider Details

I. General information

NPI: 1992374771
Provider Name (Legal Business Name): XIAOYU SHI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4266 KISSENA BLVD FL1
FLUSHING NY
11355-3213
US

IV. Provider business mailing address

366 5TH AVE FL4
NEW YORK NY
10001-2241
US

V. Phone/Fax

Practice location:
  • Phone: 718-888-7907
  • Fax:
Mailing address:
  • Phone: 917-285-2780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number347897
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number755941
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: