Healthcare Provider Details

I. General information

NPI: 1275279770
Provider Name (Legal Business Name): DUKE P SHEN DO, MENG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2022
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST STE 3020
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y ST STE 3020
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-6688
  • Fax:
Mailing address:
  • Phone: 916-734-6688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number20A24934
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A24934
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20A24934
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: