Provider Demographics
NPI:1235454836
Name:WANG, XUEYUAN SHELLY (MD)
Entity Type:Individual
Prefix:
First Name:XUEYUAN
Middle Name:SHELLY
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 CENTRE AVE
Mailing Address - Street 2:SON BLDG., ROOM 209
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2301 ERWIN RD
Practice Address - Street 2:HAFS BUILDING 5TH FLOOR
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-1304
Practice Address - Country:US
Practice Address - Phone:919-681-9660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-01879207LC0200X
PAMT196817390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine