Individual provider Active NPI

Shan Shan Chen, FNP

  • Family Nurse Practitioner
  • Forest Hills, NY
National Provider Identifier
1043053069
Registry record updated Nov 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
354359 Issued in NY
Practice address
7120 110TH St
Forest Hills, NY 11375-4844
Phone
(872) 231-3162
Fax
(702) 977-1496
NPI assigned
Jun 17, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 354359 NY Primary

Addresses

Primary practice location

7120 110TH St
Forest Hills, NY 11375-4844

Mailing address

PO Box 22239
New York, NY 10087-0001
Phone (702) 899-0595

Other practice location 1

7005 35th Ave
Jackson Heights, NY 11372-3970
Phone (872) 231-3162

Other practice location 2

26019 Nassau Blvd
Little Neck, NY 11362-2241
Phone (872) 231-3162

Other identifiers 1

IdentifierTypeStateIssuer
07967893MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240903003434 NY Practitioner - Nurse Practitioner 6204375363 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

7005 35TH Ave
Jackson Heights, NY 11372-3970
Phone (201) 654-6397

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1718582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763078400000",
    "number": "1043053069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22239",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100870001",
            "telephone_number": "702-899-0595",
            "fax_number": "702-977-1496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7120 110TH ST",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113754844",
            "telephone_number": "872-231-3162",
            "fax_number": "702-977-1496"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7005 35th Ave",
            "address_purpose": "LOCATION",
            "city": "Jackson Heights",
            "state": "NY",
            "postal_code": "113723970",
            "country_code": "US",
            "telephone_number": "872-231-3162",
            "fax_number": "702-977-1496",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "26019 Nassau Blvd",
            "address_purpose": "LOCATION",
            "city": "Little Neck",
            "state": "NY",
            "postal_code": "113622241",
            "country_code": "US",
            "telephone_number": "872-231-3162",
            "fax_number": "702-977-1496",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHEN",
        "first_name": "SHAN SHAN",
        "name_prefix": "Ms.",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-17",
        "last_updated": "2025-11-14",
        "certification_date": "2025-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "354359",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07967893",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

Verify at the official NPI Registry.