Provider Demographics
NPI:1962573428
Name:SHEN, JIE (LAC)
Entity type:Individual
Prefix:MS
First Name:JIE
Middle Name:
Last Name:SHEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 GLEN ROAD
Mailing Address - Street 2:
Mailing Address - City:SLOATSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10974
Mailing Address - Country:US
Mailing Address - Phone:845-248-2974
Mailing Address - Fax:814-368-5283
Practice Address - Street 1:11 GLEN RD
Practice Address - Street 2:
Practice Address - City:SLOATSBURG
Practice Address - State:NY
Practice Address - Zip Code:10974-1804
Practice Address - Country:US
Practice Address - Phone:845-248-2974
Practice Address - Fax:814-368-5283
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001831171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist