Provider Demographics
NPI:1790248136
Name:SHI, EDWARD YUE (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:YUE
Last Name:SHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WASHINGTON ST # 836
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1552
Mailing Address - Country:US
Mailing Address - Phone:617-636-5400
Mailing Address - Fax:617-636-8319
Practice Address - Street 1:800 WASHINGTON ST # 836
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-1619
Practice Address - Fax:617-636-8215
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2020-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA279944207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine