Healthcare Provider Details

I. General information

NPI: 1124155866
Provider Name (Legal Business Name): JEN-HWEI CHENG CRNA , RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 SHELBURNE RD
STAMFORD CT
06902-3628
US

IV. Provider business mailing address

1055 WASHINGTON BLVD SUITE 440
STAMFORD CT
06901-2216
US

V. Phone/Fax

Practice location:
  • Phone: 203-276-7000
  • Fax:
Mailing address:
  • Phone: 203-348-2614
  • Fax: 203-325-8677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR38881
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: