Healthcare Provider Details

I. General information

NPI: 1740151935
Provider Name (Legal Business Name): CHRISTIE SHEN DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3767 HYLAN BLVD
STATEN ISLAND NY
10308-3505
US

IV. Provider business mailing address

3767 HYLAN BLVD
STATEN ISLAND NY
10308-3505
US

V. Phone/Fax

Practice location:
  • Phone: 718-966-2720
  • Fax:
Mailing address:
  • Phone: 929-274-0941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number065068
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: