Provider Demographics
NPI:1730442013
Name:CHEN, SHIUNRU J (MD)
Entity type:Individual
Prefix:
First Name:SHIUNRU
Middle Name:J
Last Name:CHEN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:SHIUNRU
Other - Middle Name:JESSICA
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:110 W SQUANTUM ST
Mailing Address - Street 2:
Mailing Address - City:NORTH QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2122
Mailing Address - Country:US
Mailing Address - Phone:617-376-3000
Mailing Address - Fax:617-690-6902
Practice Address - Street 1:53 STATE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-2820
Practice Address - Country:US
Practice Address - Phone:888-663-6331
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA264586207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400250607Medicare PIN