Shidong Su, MD,PC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

215043 Issued in NY

Legal business name

SHIDONG SU, MD,PC

Practice address

13621 Roosevelt Ave
Suite 305
Flushing, NY 11354-5507

Phone

(718) 888-1803

Fax

(718) 888-0957

NPI assigned

Oct 12, 2006

Organization subpart

No

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

Authorized official

Name

Shidong Su, M.D.

Title

Director

Phone

(718) 888-1803

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467542530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13621 ROOSEVELT AVE",
            "address_2": "SUITE 305",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113545507",
            "telephone_number": "718-888-1803",
            "fax_number": "718-888-0957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13621 ROOSEVELT AVE",
            "address_2": "SUITE 305",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113545507",
            "telephone_number": "718-888-1803",
            "fax_number": "718-888-0957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHIDONG SU, MD,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SU",
        "authorized_official_first_name": "SHIDONG",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "718-888-1803",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NY",
            "license": "215043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI-MEDICARE",
            "identifier": "05353",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02159286",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Min Shi
• Wendy Shi
• Xiandong Shi, M.D.
• Xiaoyu Shi, NP
• Ximing Shi, LMT
• Miriam Shields, PSYD
• Rick Shields, CDN PHD
• Jennifer Kathleen Shih
• Juien Shih
• Pei-Yu Shih

• Neurology Physician in Flushing, NY
• Providers in Flushing, NY by specialty
• Neurology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.