Provider Demographics
NPI:1952690612
Name:MAO, SHENGYI (MD)
Entity Type:Individual
Prefix:
First Name:SHENGYI
Middle Name:
Last Name:MAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-7980
Mailing Address - Fax:614-293-7981
Practice Address - Street 1:895 YARD ST
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:OH
Practice Address - Zip Code:43212-3886
Practice Address - Country:US
Practice Address - Phone:614-293-7980
Practice Address - Fax:614-293-7981
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.019395207R00000X
OH35120980208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0123316Medicaid