Healthcare Provider Details

I. General information

NPI: 1932969540
Provider Name (Legal Business Name): NANCY SHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S EUCLID AVE
SAINT LOUIS MO
63110-1010
US

IV. Provider business mailing address

4401 CHOUTEAU AVE APT 2307
SAINT LOUIS MO
63110-1604
US

V. Phone/Fax

Practice location:
  • Phone: 314-273-3376
  • Fax: 314-362-6080
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2025017041
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: