Provider Demographics
NPI:1124044334
Name:SHA, ZHIYI (MD)
Entity Type:Individual
Prefix:DR
First Name:ZHIYI
Middle Name:
Last Name:SHA
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 1:420 DELAWARE STREET S.E., MMC 295
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-624-9025
Mailing Address - Fax:612-624-8111
Practice Address - Street 1:420 DELAWARE STREET S.E., MMC 295
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-624-9025
Practice Address - Fax:612-624-8111
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87661207T00000X
MN879022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN984662100Medicaid
CA00A876610OtherMEDICAL PPIN #
CAI00935Medicare UPIN
CA00A876610OtherMEDICAL PPIN #
MN984662100Medicaid