Provider Demographics
NPI:1386034791
Name:SHEN, CHEN
Entity Type:Individual
Prefix:
First Name:CHEN
Middle Name:
Last Name:SHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4028 COLLEGE POINT BLVD
Mailing Address - Street 2:UNIT 907
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5105
Mailing Address - Country:US
Mailing Address - Phone:646-322-3483
Mailing Address - Fax:
Practice Address - Street 1:4028 COLLEGE POINT BLVD
Practice Address - Street 2:UNIT 907
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5105
Practice Address - Country:US
Practice Address - Phone:646-322-3483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-24
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058378183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist