Provider Demographics
NPI:1912046673
Name:SHI, QINGYAO (LIC ACU)
Entity Type:Individual
Prefix:MRS
First Name:QINGYAO
Middle Name:
Last Name:SHI
Suffix:
Gender:F
Credentials:LIC ACU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 CHESTNUT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-4108
Mailing Address - Country:US
Mailing Address - Phone:215-751-9833
Mailing Address - Fax:
Practice Address - Street 1:1737 CHESTNUT ST STE 200
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-4108
Practice Address - Country:US
Practice Address - Phone:215-751-9833
Practice Address - Fax:215-575-0454
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000219L171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist