Healthcare Provider Details

I. General information

NPI: 1861704926
Provider Name (Legal Business Name): DR. PHILLIP Y SHOU PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 BOULEVARD SUITE D
COLONIAL HEIGHTS VA
23834-2323
US

IV. Provider business mailing address

2801 BOULEVARD SUITE D
COLONIAL HEIGHTS VA
23834-2323
US

V. Phone/Fax

Practice location:
  • Phone: 804-526-3821
  • Fax: 804-526-6065
Mailing address:
  • Phone: 804-526-3821
  • Fax: 804-526-6065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101041517
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101041517
License Number StateVA

VIII. Authorized Official

Name: DR. PHILLIP Y SHOU
Title or Position: OFFICER
Credential: M.D
Phone: 804-526-3821