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General NPI Number Information
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NPI Number | 1417456302
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Entity Type | Individual
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Provider Name | SHENG YUN PENG DNP
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Gender | Female
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Dates
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Enumeration Date | 02/06/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 14780 W MOUNTAIN VIEW BLVD. SUITE # 110
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City | SURPRISE
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State | AZ
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Zip | 85374
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Country | US
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Telephone | 623-777-7212
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Fax |
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Provider Business Mailing Address
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Address Line | 1958 S. MARTINGALE RD
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City | GILBERT
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State | AZ
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Zip | 85295
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Country | US
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Telephone | 917-330-4156
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | TAP10933
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License Number State | AZ
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