SHIDONG SU MDPC NPI 1467542530

NPI Information

NPI: 1467542530
Provider Name: SHIDONG SU, MD,PC
Classification: Psychiatry & Neurology - 2084N0400X
Specialization: Neurology
Entity Type: Organization
Address: 13621 ROOSEVELT AVE
SUITE 305
FLUSHING, NY
ZIP 11354
Phone: (718) 888-1803

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NPI Details

SHIDONG SU, MD,PC is a neurology psychiatry neurology in Flushing, NY. The provider is a Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. SHIDONG SU, MD,PC NPI is 1467542530. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

13621 ROOSEVELT AVE
SUITE 305
FLUSHING, NY
ZIP 11354-507
Phone: (718) 888-1803
Fax: (718) 888-0957

The provider's authorized official is Shidong Su .
The authorized official title is Director and has the following contact phone number (718) 888-1803.

The enumeration date for this NPI number is 10/12/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2084N0400X	Psychiatry & Neurology	Neurology	215043	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	05353	OTHER	NEW YORK	GHI-MEDICARE
2	02159286	MEDICAID	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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