Healthcare Provider Details

I. General information

NPI: 1750106860
Provider Name (Legal Business Name): XINGXING SHI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 OLD SHEPARD PL STE 401
PLANO TX
75093-5274
US

IV. Provider business mailing address

4601 OLD SHEPARD PL STE 401
PLANO TX
75093-5274
US

V. Phone/Fax

Practice location:
  • Phone: 972-612-5370
  • Fax: 972-476-1138
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number256758
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number256758
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: