Provider Demographics
NPI:1063673432
Name:SHANG, TERRY XIAOZHOU (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:XIAOZHOU
Last Name:SHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 S BURLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-3479
Mailing Address - Country:US
Mailing Address - Phone:856-459-7000
Mailing Address - Fax:
Practice Address - Street 1:215 S BURLINGTON RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-3479
Practice Address - Country:US
Practice Address - Phone:856-459-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA087361002084P0800X
PAMD4382662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry