Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 25MA10220500 | NJ |
Y | 208600000X | Surgeon | 25MA10220500 | NJ |
N | 2086X0206X | Surgical Oncologist | 25MA10220500 | NJ |
N | 2086X0206X | Surgical Oncologist | MD457617 | PA |
N | 2086X0206X | Surgical Oncologist | P3584 | TX |
NPI | 1154686640 |
---|---|
Provider Name | Michelle Chout-Win Shen |
First Address | Marlton, NJ 08053-4197 |
Second Address | Moorestown, NJ 08057-3130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2012 |
Last Update Date | 16/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0601322 | (05) | NJ |
8DH743 | BCBS (01) | TX |