Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DN25511 | FL |
NPI | 1013457696 |
---|---|
Provider Name | Dr. Si Shi |
First Address | Jacksonville, FL 32246-0040 |
Second Address | Jacksonville, FL 32204-3373 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2017 |
Last Update Date | 14/07/2021 |