Provider Demographics
NPI:1891768248
Name:FOO, SHIYIN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SHIYIN
Middle Name:
Last Name:FOO
Suffix:
Gender:F
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 1:17 NEWELL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6606
Mailing Address - Country:US
Mailing Address - Phone:617-264-4472
Mailing Address - Fax:
Practice Address - Street 1:220 MASSACHUSETTS AVE
Practice Address - Street 2:368F
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4229
Practice Address - Country:US
Practice Address - Phone:617-872-4986
Practice Address - Fax:617-871-5203
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216105207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2104881Medicaid
MA468418OtherTUFTS HEALTH PLAN
MAJ28931OtherBCBS MA
MA2104881Medicaid
MAJ28931OtherBCBS MA