Provider Demographics
NPI:1821898271
Name:SHAO, TIAN YU
Entity type:Individual
Prefix:
First Name:TIAN
Middle Name:YU
Last Name:SHAO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 POLLY DRUMMOND SHPG CTR STE 1
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-4861
Mailing Address - Country:US
Mailing Address - Phone:302-883-7336
Mailing Address - Fax:
Practice Address - Street 1:16 POLLY DRUMMOND SHPG CTR STE 1
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-4861
Practice Address - Country:US
Practice Address - Phone:302-883-7336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-15
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEMT-0002077225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist