Provider Demographics
NPI:1306219712
Name:LI, SHIFAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIFAN
Middle Name:
Last Name:LI
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 1:990 SOUTH AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2762
Mailing Address - Country:US
Mailing Address - Phone:856-236-4893
Mailing Address - Fax:
Practice Address - Street 1:990 SOUTH AVE STE 207
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2762
Practice Address - Country:US
Practice Address - Phone:585-341-6775
Practice Address - Fax:585-341-8310
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program