Provider Demographics
NPI:1497510523
Name:SHI, FANGYING STEPHANIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:FANGYING
Middle Name:STEPHANIE
Last Name:SHI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 228TH AVE NE STE 1068
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-7222
Mailing Address - Country:US
Mailing Address - Phone:425-358-8087
Mailing Address - Fax:
Practice Address - Street 1:25709 SE 32ND PL
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075-9165
Practice Address - Country:US
Practice Address - Phone:425-358-8087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006062103TC0700X
WA61466990103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical