Provider Demographics
NPI:1538541503
Name:WU, SHAN SHAN (DO)
Entity type:Individual
Prefix:DR
First Name:SHAN SHAN
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5915 LANDERBROOK DR STE 110
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4034
Mailing Address - Country:US
Mailing Address - Phone:216-381-3333
Mailing Address - Fax:216-381-3002
Practice Address - Street 1:5915 LANDERBROOK DR STE 110
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-4034
Practice Address - Country:US
Practice Address - Phone:216-381-3333
Practice Address - Fax:216-381-3002
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34014489207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0403895Medicaid