Provider Demographics
NPI:1467414078
Name:SHAO, HAIPENG (MD, PHD)
Entity Type:Individual
Prefix:
First Name:HAIPENG
Middle Name:
Last Name:SHAO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12902 USF MAGNOLIA DR
Mailing Address - Street 2:MCC LAB
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-9416
Mailing Address - Country:US
Mailing Address - Phone:813-745-2672
Mailing Address - Fax:813-745-1708
Practice Address - Street 1:12902 USF MAGNOLIA DR
Practice Address - Street 2:MCC LAB
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9416
Practice Address - Country:US
Practice Address - Phone:813-745-2672
Practice Address - Fax:813-745-1708
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI1409207ZP0105X
FLME106987291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine