Healthcare Provider Details

I. General information

NPI: 1053307959
Provider Name (Legal Business Name): CINDY QINGXIN SHI MD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 WINDSOR RD
RED LION PA
17356-8656
US

IV. Provider business mailing address

1803 MOUNT ROSE AVE SUITE B2
YORK PA
17403-3026
US

V. Phone/Fax

Practice location:
  • Phone: 717-246-3908
  • Fax:
Mailing address:
  • Phone: 717-851-1405
  • Fax: 717-812-4087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberMD067998L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD067998L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberBS6481989
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: