Provider Demographics
NPI:1639651375
Name:PENG, SHAUE-FUNG C
Entity Type:Individual
Prefix:
First Name:SHAUE-FUNG
Middle Name:C
Last Name:PENG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SPRING LN
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2261
Mailing Address - Country:US
Mailing Address - Phone:781-806-5106
Mailing Address - Fax:
Practice Address - Street 1:316 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2292
Practice Address - Country:US
Practice Address - Phone:617-984-8747
Practice Address - Fax:617-984-8711
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10193641041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool