Provider Demographics
NPI:1881736775
Name:SHANG, XIAOLI (LAC)
Entity type:Individual
Prefix:
First Name:XIAOLI
Middle Name:
Last Name:SHANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5022 40TH ST
Mailing Address - Street 2:5B
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-4143
Mailing Address - Country:US
Mailing Address - Phone:212-920-5820
Mailing Address - Fax:
Practice Address - Street 1:6044 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-5907
Practice Address - Country:US
Practice Address - Phone:718-386-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1302171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist