Provider Demographics
NPI:1235905001
Name:SHI, DAVIE WEIHUAN
Entity Type:Individual
Prefix:
First Name:DAVIE
Middle Name:WEIHUAN
Last Name:SHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:WEIHUAN
Other - Middle Name:
Other - Last Name:SHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11922 NATHANSHILL LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-1769
Mailing Address - Country:US
Mailing Address - Phone:513-372-0858
Mailing Address - Fax:
Practice Address - Street 1:332 S MICHIGAN AVE STE 900
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-4393
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-23-313222106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician