Most Relevant Information
Provider Data
| NPI Number: | 1003436999 |
| Provider Name: | JOHANNA SHEA-FEN TAN |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/20/2020 |
| Last Updated: | 04/20/2020 |
Provider Practice Location
111 E 210TH ST
BRONX
NY
104672401
Practice Location Phone/Fax
| Phone: | 7189204321 |
| Fax: |
Provider Mailing Location
111 E 210TH ST
BRONX
NY
104672401
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |