Provider Demographics
NPI:1114292406
Name:GIPSON, SHIH YEE-MARIE TAN (MD)
Entity Type:Individual
Prefix:
First Name:SHIH
Middle Name:YEE-MARIE TAN
Last Name:GIPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHIH
Other - Middle Name:YEE-MARIE
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:185 CAMBRIDGE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2790
Mailing Address - Country:US
Mailing Address - Phone:617-643-2780
Mailing Address - Fax:
Practice Address - Street 1:18 GROVE ST # 6
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7705
Practice Address - Country:US
Practice Address - Phone:617-326-5102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2623762084P0800X, 2084P0804X
CAA1550112084P0804X, 2084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program