Provider Demographics
NPI:1669554077
Name:SHENG, SAMUEL (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:SHENG
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:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:1525 S COOPER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-4105
Practice Address - Country:US
Practice Address - Phone:817-804-1100
Practice Address - Fax:817-299-8790
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1391208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89240SOtherBCBSTX IND PIN
1750369203OtherGRP NPI NUMBER
TX5208023OtherAETNA PIN
TX121314202Medicaid
3864022OtherECFMG PIN
TXSHESF47936OtherCCHIP PIN
TX140442869Medicaid
TX00U87ZOtherBCBSTX GRP PIN
TX1305238OtherUHC PIN
TX140442830Medicaid
TX828135OtherFIRSTHEALTH PIN
TX8563120OtherCIGNA PIN
TX828135OtherFIRSTHEALTH PIN
TX5208023OtherAETNA PIN
TX86940KMedicare ID - Type UnspecifiedIND MEDICARE