Provider Demographics
NPI:1992727739
Name:SHEN, LIN (RPA-C, LAC)
Entity type:Individual
Prefix:
First Name:LIN
Middle Name:
Last Name:SHEN
Suffix:
Gender:F
Credentials:RPA-C, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 BELL BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2222
Mailing Address - Country:US
Mailing Address - Phone:718-357-3638
Mailing Address - Fax:
Practice Address - Street 1:2415 BELL BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2222
Practice Address - Country:US
Practice Address - Phone:718-357-3638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002774-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist