MEDICARE: SHITING XIE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	ATH1726	SC
2	390200000X	Student in an Organized Health Care Education/Training Program
3	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1295401958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHITING XIE

Provider Business Mailing Address
First Line	:	1461 WORTHINGTON ST APT F
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43201-2759
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1461 WORTHINGTON ST APT F
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43201-2759
Country	:	US
Telephone Number	:	626-999-1273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2021
Last Update Date	:	11/21/2024

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Directions to “ SHITING XIE ” Practice Location

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