Active NPI
Ellen Pauline Shen, D.O.
- Pediatrics Physician
- Mequon, WI
National Provider Identifier
1114227626
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 60732-21
- Practice address
- 10532 N Port Washington Rd
Suite 1a
Mequon, WI 53092-5563 - Phone
- (262) 240-9744
- Fax
- (262) 240-9745
- NPI assigned
- Oct 31, 2010
- Last updated
- Jul 23, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 60732-21 | WI | Primary |
Addresses
Primary practice location
10532 N Port Washington Rd
Suite 1a
Mequon, WI 53092-5563
Mailing address
10532 N Port Washington Rd
Suite 1a
Mequon, WI 53092-5563
Phone (262) 240-9744
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60732-21 | WI | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children's Medical Group | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- eshen25035@direct.chw.org
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374537600000",
"number": "1114227626",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10532 N PORT WASHINGTON RD",
"address_2": "SUITE 1A",
"city": "MEQUON",
"state": "WI",
"postal_code": "530925563",
"telephone_number": "262-240-9744",
"fax_number": "262-240-9745"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10532 N PORT WASHINGTON RD",
"address_2": "SUITE 1A",
"city": "MEQUON",
"state": "WI",
"postal_code": "530925563",
"telephone_number": "262-240-9744",
"fax_number": "262-240-9745"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEN",
"first_name": "ELLEN",
"middle_name": "PAULINE",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-10-31",
"last_updated": "2013-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WI",
"license": "60732-21",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mequon, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.