Provider Demographics
NPI:1881635134
Name:SHEN, ANGELA (OD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:SHEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:SHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2348 COLONY CROSSING PLACE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4292
Mailing Address - Country:US
Mailing Address - Phone:804-639-2204
Mailing Address - Fax:
Practice Address - Street 1:2348 COLONY CROSSING PLACE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4280
Practice Address - Country:US
Practice Address - Phone:804-639-2204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAMS0867486152W00000X
VA0618000671152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9233831Medicaid
VA1881635134Medicaid
VA018410B19Medicare PIN