Provider Demographics
NPI:1063836708
Name:SHU, MENGDA (CMD)
Entity Type:Individual
Prefix:PROF
First Name:MENGDA
Middle Name:
Last Name:SHU
Suffix:
Gender:F
Credentials:CMD
Other - Prefix:MS
Other - First Name:MENGDA
Other - Middle Name:
Other - Last Name:SHU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMD
Mailing Address - Street 1:6705 GOLDSBORO RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-5417
Mailing Address - Country:US
Mailing Address - Phone:301-320-8628
Mailing Address - Fax:
Practice Address - Street 1:50 W GUDE DR # 48-54
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1150
Practice Address - Country:US
Practice Address - Phone:301-320-8628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDUOO566171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist