Provider Demographics
NPI:1902077035
Name:LIU, SHIRLEY H (MD)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:H
Last Name:LIU
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 1:1340 TULLY RD STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-3055
Mailing Address - Country:US
Mailing Address - Phone:650-268-4250
Mailing Address - Fax:
Practice Address - Street 1:1340 TULLY RD STE 301
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-3055
Practice Address - Country:US
Practice Address - Phone:650-268-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2574242084P0804X
CAA950042084P0800X, 2084P0804X
MA2359572084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00356318Medicaid
331817OtherMEDICARE PROVIDER NUMBER