Provider Demographics
NPI:1275294407
Name:SHIN, ANGELA SUHYOUNG
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:SUHYOUNG
Last Name:SHIN
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 1:410 SPRINGTREE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75065-2391
Mailing Address - Country:US
Mailing Address - Phone:972-849-2816
Mailing Address - Fax:
Practice Address - Street 1:410 SPRINGTREE RD
Practice Address - Street 2:
Practice Address - City:LAKE DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75065-2391
Practice Address - Country:US
Practice Address - Phone:972-849-2816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX421692355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant