Healthcare Provider Details

I. General information

NPI: 1639620446
Provider Name (Legal Business Name): SHANA RAE CHUNG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 DICKINSON DR STE 107
CHADDS FORD PA
19317-9689
US

IV. Provider business mailing address

PO BOX 306704
NASHVILLE TN
37230-6704
US

V. Phone/Fax

Practice location:
  • Phone: 610-361-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberSP016530
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP016530
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: