Provider Demographics
NPI:1114219185
Name:SHEN, ALICE SHIH YUAN (MD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:SHIH YUAN
Last Name:SHEN
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 1:212 W PACKER AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-2060
Mailing Address - Country:US
Mailing Address - Phone:518-810-7900
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-882-3585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT199058208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery