Provider Demographics
NPI:1740207471
Name:HE, SHUNIAN (MD)
Entity Type:Individual
Prefix:
First Name:SHUNIAN
Middle Name:
Last Name:HE
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 1:116 CANTERBURY HILL RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-4924
Mailing Address - Country:US
Mailing Address - Phone:774-437-8887
Mailing Address - Fax:
Practice Address - Street 1:640 BOLTON ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3999
Practice Address - Country:US
Practice Address - Phone:508-481-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206099207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2132079Medicaid
MA2132079Medicaid