Healthcare Provider Details

I. General information

NPI: 1619888773
Provider Name (Legal Business Name): NINOSKA WONG SHING LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W DUNCANNON AVE
PHILADELPHIA PA
19120-3410
US

IV. Provider business mailing address

1928 CONWELL AVE
PHILADELPHIA PA
19115-1728
US

V. Phone/Fax

Practice location:
  • Phone: 215-400-9141
  • Fax:
Mailing address:
  • Phone: 215-850-6451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberPC004918
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: