Healthcare Provider Details

I. General information

NPI: 1487598017
Provider Name (Legal Business Name): CHRISTINE SHI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NICOLLS RD FL 19
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

101 NICOLLS RD FL 19
STONY BROOK NY
11794-0001
US

V. Phone/Fax

Practice location:
  • Phone: 631-638-2396
  • Fax: 631-444-8988
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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: