Healthcare Provider Details

I. General information

NPI: 1174159073
Provider Name (Legal Business Name): SHELBY TARA CHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 STOCKTON BLVD STE 216
SACRAMENTO CA
95817-2208
US

IV. Provider business mailing address

2516 STOCKTON BLVD STE 216
SACRAMENTO CA
95817-2208
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7098
  • Fax: 916-734-7070
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberA179434
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: