Healthcare Provider Details

I. General information

NPI: 1740833151
Provider Name (Legal Business Name): SHIRLEY CHEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 01/03/2022
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR
STANFORD CA
94305-2200
US

IV. Provider business mailing address

2738 MIDDLEBOROUGH CIR
SAN JOSE CA
95132-2115
US

V. Phone/Fax

Practice location:
  • Phone: 650-497-8057
  • Fax:
Mailing address:
  • Phone: 408-393-3082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95022106
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95001191
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: