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General NPI Number Information
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NPI Number | 1336741750
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Entity Type | Individual
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Provider Name | CHAO SHEN
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Gender | Male
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Dates
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Enumeration Date | 11/10/2020
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 2480 LLEWELLYN AVE
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City | FORT GEORGE G MEADE
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State | MD
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Zip | 20755-5129
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Country | US
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Telephone | 301-677-8196
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Fax |
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Provider Business Mailing Address
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Address Line | 5663 ZOE LN
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City | FREDERICK
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State | MD
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Zip | 21704-7554
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4006618
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1116428
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License Number State | KY
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