Provider Demographics
NPI:1609859198
Name:CHEN, SHANWAN (MD)
Entity Type:Individual
Prefix:
First Name:SHANWAN
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6962 230TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3120
Mailing Address - Country:US
Mailing Address - Phone:718-886-4977
Mailing Address - Fax:718-886-4692
Practice Address - Street 1:13625 37TH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4169
Practice Address - Country:US
Practice Address - Phone:718-886-4977
Practice Address - Fax:718-886-4692
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2097722084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02011094Medicaid
NY03684Medicare ID - Type Unspecified
NYH03360Medicare UPIN