Provider Demographics
NPI:1104194257
Name:SHEN, CARRIE ELIZABETH
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ELIZABETH
Last Name:SHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 STRATFORD CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-4214
Mailing Address - Country:US
Mailing Address - Phone:630-839-9685
Mailing Address - Fax:
Practice Address - Street 1:105 STRATFORD CT
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-4214
Practice Address - Country:US
Practice Address - Phone:630-839-9685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist