Provider Demographics
NPI:1861637381
Name:DR. SHAN PSYCHIATRY CLINIC LLC
Entity Type:Organization
Organization Name:DR. SHAN PSYCHIATRY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YANG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-533-3660
Mailing Address - Street 1:756 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-2330
Mailing Address - Country:US
Mailing Address - Phone:215-533-3660
Mailing Address - Fax:215-533-3682
Practice Address - Street 1:756 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-2330
Practice Address - Country:US
Practice Address - Phone:215-533-3660
Practice Address - Fax:215-533-3682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421627103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty