Healthcare Provider Details

I. General information

NPI: 1073856027
Provider Name (Legal Business Name): NICOLE TSEIN SHEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 S BRENTWOOD BLVD STE 555
SAINT LOUIS MO
63117-1265
US

IV. Provider business mailing address

40 LOREN WOODS DR
SAINT LOUIS MO
63124-1903
US

V. Phone/Fax

Practice location:
  • Phone: 724-816-3152
  • Fax:
Mailing address:
  • Phone: 724-816-3152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2020008440
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: