Provider Demographics
NPI:1518051259
Name:TUNG, SHIRLEY (MSS)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:TUNG
Suffix:
Gender:F
Credentials:MSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 LARCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-2020
Mailing Address - Country:US
Mailing Address - Phone:610-246-6612
Mailing Address - Fax:
Practice Address - Street 1:43 LEOPARD RD STE 204
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1552
Practice Address - Country:US
Practice Address - Phone:610-285-8797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0128111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA172990000OtherKEYSTONE
PA7957288OtherAETNA
PA2320959000OtherIBC