Provider Demographics
NPI:1942207576
Name:WONG, SHE LING (MD)
Entity Type:Individual
Prefix:DR
First Name:SHE
Middle Name:LING
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1558 NW 48TH PL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-3339
Mailing Address - Country:US
Mailing Address - Phone:956-459-0933
Mailing Address - Fax:
Practice Address - Street 1:5130 LINTON BLVD STE H1H3
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6596
Practice Address - Country:US
Practice Address - Phone:561-819-6125
Practice Address - Fax:561-819-6127
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7252208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110547001Medicaid
TX00N86SMedicare ID - Type Unspecified