Provider Demographics
NPI:1114227626
Name:SHEN, ELLEN PAULINE (DO)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:PAULINE
Last Name:SHEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10532 N PORT WASHINGTON RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5563
Mailing Address - Country:US
Mailing Address - Phone:262-240-9744
Mailing Address - Fax:262-240-9745
Practice Address - Street 1:10532 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5563
Practice Address - Country:US
Practice Address - Phone:262-240-9744
Practice Address - Fax:262-240-9745
Is Sole Proprietor?:No
Enumeration Date:2010-10-31
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60732-21208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics