Healthcare Provider Details

I. General information

NPI: 1689645475
Provider Name (Legal Business Name): SHU-CHUNG SHIH CHENG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2094 PITKIN AVE
BROOKLYN NY
11207-3509
US

IV. Provider business mailing address

29 FENIMORE RD
SCARSDALE NY
10583-2250
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-0480
  • Fax: 718-240-0564
Mailing address:
  • Phone: 914-725-0009
  • Fax: 914-725-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number135105
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: