Provider Demographics
NPI:1013478049
Name:SHI, LUCY (DO)
Entity type:Individual
Prefix:DR
First Name:LUCY
Middle Name:
Last Name:SHI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1683 GILBERT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23511-0018
Mailing Address - Country:US
Mailing Address - Phone:757-763-8640
Mailing Address - Fax:
Practice Address - Street 1:6905 HARRIS AVE
Practice Address - Street 2:
Practice Address - City:MCBH
Practice Address - State:HI
Practice Address - Zip Code:98734
Practice Address - Country:US
Practice Address - Phone:808-257-3365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-31
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102206357208D00000X, 208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice