Provider Demographics
NPI:1891236196
Name:CHEN, SHEN EN (MD, MPH, PHD)
Entity Type:Individual
Prefix:DR
First Name:SHEN EN
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD, MPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N. STATE STREET
Mailing Address - Street 2:DEPARTMENT OF NEUROLOGY
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216
Mailing Address - Country:US
Mailing Address - Phone:601-984-5514
Mailing Address - Fax:601-984-5503
Practice Address - Street 1:2500 N. STATE STREET
Practice Address - Street 2:DEPARTMENT OF NEUROLOGY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-984-5514
Practice Address - Fax:601-984-5503
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS27962208D00000X, 207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program