Healthcare Provider Details

I. General information

NPI: 1407134224
Provider Name (Legal Business Name): MILI SHUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 WESTCHESTER AVE
WEST HARRISON NY
10604-2906
US

IV. Provider business mailing address

1338 S FOOTHILL DR # 199
SALT LAKE CITY UT
84108-2321
US

V. Phone/Fax

Practice location:
  • Phone: 914-493-7585
  • Fax:
Mailing address:
  • Phone: 347-815-5133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number11415615-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11415615-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: