Provider Demographics
NPI:1275653628
Name:SHEN, MIN YOU (LAC LICENSED ACUPUNC)
Entity type:Individual
Prefix:MR
First Name:MIN
Middle Name:YOU
Last Name:SHEN
Suffix:
Gender:M
Credentials:LAC LICENSED ACUPUNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 75 37 AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-463-1133
Mailing Address - Fax:718-463-1355
Practice Address - Street 1:136 75 37 AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-463-1133
Practice Address - Fax:718-463-1355
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003332171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist