Healthcare Provider Details

I. General information

NPI: 1629042841
Provider Name (Legal Business Name): PETER U SHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14225 NEWBROOK DR
CHANTILLY VA
20151-2228
US

IV. Provider business mailing address

13224 LADYBANK LN
HERNDON VA
20171-4030
US

V. Phone/Fax

Practice location:
  • Phone: 703-802-7086
  • Fax:
Mailing address:
  • Phone: 703-956-6986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number39600
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number39600
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: