Provider Demographics
NPI:1164286753
Name:SHEN RADIANCE, LLC
Entity Type:Organization
Organization Name:SHEN RADIANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FATMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINHAS-KUCUK
Authorized Official - Suffix:
Authorized Official - Credentials:DAC, LAC
Authorized Official - Phone:914-482-3945
Mailing Address - Street 1:55 VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1829
Mailing Address - Country:US
Mailing Address - Phone:914-482-3945
Mailing Address - Fax:
Practice Address - Street 1:50 CHURCH ST STE L4
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2745
Practice Address - Country:US
Practice Address - Phone:914-482-3945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service