Dallas Shujing Shi, MD, PHD, MBA

Primary specialty

Occupational Medicine PhysicianTaxonomy code 2083X0100X

License

11405462-1205 Issued in UT

Practice address

391 S Chipeta Way Ste C
Salt Lake City, UT 84108-1294

Phone

(801) 581-4800

NPI assigned

Apr 10, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration, Doctor of Medicine, Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568332800000",
    "number": "1407353089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "391 S CHIPETA WAY STE C",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081294",
            "telephone_number": "801-581-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "391 S CHIPETA WAY STE C",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081294",
            "telephone_number": "801-581-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHI",
        "first_name": "DALLAS",
        "middle_name": "SHUJING",
        "name_prefix": "Dr.",
        "credential": "MD, PHD, MBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-10",
        "last_updated": "2019-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "UT",
            "license": "11405462-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Antonia Ford Sherwood, RN, CPNP, CHPPN
• Kelly Larrabee Sherwood, PA
• Ganna Shestakova, M.D. PH.D.
• Samuel Kirk Shewan, PA-C
• David Shewell, MD
• Trevor Steven Shick
• Shields Youth and Adult Services
• Csensi-Aspen Shields
• Fantaisha Tonimarie Shields
• Jessica Shields, MS, RD, CD

• Occupational Medicine Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Occupational Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.