Provider Demographics
NPI:1952665549
Name:SHEN, AN (MA)
Entity Type:Individual
Prefix:
First Name:AN
Middle Name:
Last Name:SHEN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 LODGE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3437
Mailing Address - Country:US
Mailing Address - Phone:631-423-2194
Mailing Address - Fax:631-423-2194
Practice Address - Street 1:60 LODGE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3437
Practice Address - Country:US
Practice Address - Phone:631-423-2194
Practice Address - Fax:631-423-2194
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist