Provider Demographics
NPI:1619597903
Name:XIANG, SHUYAO
Entity Type:Individual
Prefix:
First Name:SHUYAO
Middle Name:
Last Name:XIANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 STATE HIGHWAY 303 NE STE A101
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-3629
Mailing Address - Country:US
Mailing Address - Phone:360-627-7408
Mailing Address - Fax:
Practice Address - Street 1:5050 STATE HIGHWAY 303 NE STE A101
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-3629
Practice Address - Country:US
Practice Address - Phone:360-627-7408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61055408171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA61055408OtherLICENSE