Provider Demographics
NPI:1700604725
Name:WANG, SHUFENG
Entity type:Individual
Prefix:
First Name:SHUFENG
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6351 S DESERT BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-1219
Mailing Address - Country:US
Mailing Address - Phone:915-499-0424
Mailing Address - Fax:915-260-8033
Practice Address - Street 1:6351 S DESERT BLVD STE 106
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-1219
Practice Address - Country:US
Practice Address - Phone:915-499-0424
Practice Address - Fax:915-260-8033
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT141492225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist