Provider Demographics
NPI:1376007146
Name:SHYLU, BINU
Entity Type:Individual
Prefix:
First Name:BINU
Middle Name:
Last Name:SHYLU
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 1:6120 HAGAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-0006
Mailing Address - Country:US
Mailing Address - Phone:972-997-6307
Mailing Address - Fax:
Practice Address - Street 1:6120 HAGAN HILL RD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-0006
Practice Address - Country:US
Practice Address - Phone:972-997-6307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-05-22
Deactivation Date:2019-05-12
Deactivation Code:
Reactivation Date:2019-05-22
Provider Licenses
StateLicense IDTaxonomies
TXAP138952363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner