Healthcare Provider Details

I. General information

NPI: 1902145535
Provider Name (Legal Business Name): SHANJIA CUI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3022 JAVIER RD SUITE 205
FAIRFAX VA
22031-4645
US

IV. Provider business mailing address

3022 JAVIER RD SUITE 205
FAIRFAX VA
22031-4645
US

V. Phone/Fax

Practice location:
  • Phone: 703-966-0146
  • Fax: 703-995-0638
Mailing address:
  • Phone: 703-966-0146
  • Fax: 703-995-0638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0121000686
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC500157
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU02133
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: