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NPI Code Detail

MEDICARE: DR. BRENDA SHANG CHAN MD

MEDICARE: DR. BRENDA SHANG CHAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RN0300XNephrology Physician039469CT

General Provider Information

NPI Number : 1760588198
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRENDA SHANG CHAN MD
Provider Business Mailing Address
First Line : 30 COMMERCE RD
Second Line :
City : STAMFORD
State : CT
Zip : 06902-4550
Country : US
Telephone Number : 203-324-7666
Fax Number :
Provider Business Practice Location Address
First Line : 30 COMMERCE RD
Second Line :
City : STAMFORD
State : CT
Zip : 06902-4550
Country : US
Telephone Number : 203-324-7666
Fax Number : 203-323-2541
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2006
Last Update Date : 10/16/2013

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