Provider Demographics
NPI:1811036536
Name:SHI, CHANGING
Entity Type:Individual
Prefix:
First Name:CHANGING
Middle Name:
Last Name:SHI
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 1:7401 OSLER DR
Mailing Address - Street 2:102
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7673
Mailing Address - Country:US
Mailing Address - Phone:410-828-1800
Mailing Address - Fax:410-828-7863
Practice Address - Street 1:7401 OSLER DR
Practice Address - Street 2:102
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7673
Practice Address - Country:US
Practice Address - Phone:410-828-1800
Practice Address - Fax:410-828-7863
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01117171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD624504-01OtherCAREFIRST BLUE SHIELD
MDJ427-0001OtherBLUE CHOICE