Provider Demographics
NPI:1720249121
Name:SHIN, SUSANNA H (MD)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:H
Last Name:SHIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 LAUREL OAK RD STE 105
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4455
Mailing Address - Country:US
Mailing Address - Phone:856-922-9894
Mailing Address - Fax:856-922-9890
Practice Address - Street 1:333 LAUREL OAK RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4453
Practice Address - Country:US
Practice Address - Phone:856-783-0191
Practice Address - Fax:856-783-0264
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD0398572086S0129X
NJ25MA108521002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery