Healthcare Provider Details

I. General information

NPI: 1770319741
Provider Name (Legal Business Name): DR. LONG SHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 AMHERST VILLA RD
BUFFALO NY
14225-1400
US

IV. Provider business mailing address

55 AMHERST VILLA RD
BUFFALO NY
14225-1400
US

V. Phone/Fax

Practice location:
  • Phone: 800-960-1080
  • Fax:
Mailing address:
  • Phone: 800-960-1080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License NumberSHENL2
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License NumberSHENL2
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberSHENL2
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: