Provider Demographics
NPI:1124199708
Name:WYNN, PE SHEIN (MD)
Entity Type:Individual
Prefix:MR
First Name:PE
Middle Name:SHEIN
Last Name:WYNN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2094 ALBANY POST ROAD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:NY
Mailing Address - Zip Code:10548
Mailing Address - Country:US
Mailing Address - Phone:914-737-4400
Mailing Address - Fax:845-362-8474
Practice Address - Street 1:2094 ALBANY POST ROAD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:NY
Practice Address - Zip Code:10548
Practice Address - Country:US
Practice Address - Phone:914-737-4400
Practice Address - Fax:845-632-2940
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2085052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG70920Medicare UPIN