MEDICARE: CAROL LIU SHEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0210X	Pediatric Nephrology Physician	299784	NY

General Provider Information

NPI Number	:	1205367364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL LIU SHEN M.D.

Provider Business Mailing Address
First Line	:	410 LAKEVILLE RD STE 202
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1103
Country	:	US
Telephone Number	:	718-470-3490
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 LAKEVILLE RD STE 202
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1103
Country	:	US
Telephone Number	:	718-470-3490
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	06/29/2023

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