Healthcare Provider Details

I. General information

NPI: 1689913659
Provider Name (Legal Business Name): SHIMENG TANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2013
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3380 MEMPHIS ST
PHILADELPHIA PA
19134-4510
US

IV. Provider business mailing address

929 NEWTOWN RD
DEVON PA
19333-1836
US

V. Phone/Fax

Practice location:
  • Phone: 215-426-5566
  • Fax:
Mailing address:
  • Phone: 407-459-0209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN631396
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberSP012793
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: