Provider Demographics
NPI:1376214098
Name:SHIN, JOOYUN (CNP)
Entity Type:Individual
Prefix:
First Name:JOOYUN
Middle Name:
Last Name:SHIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 NEW LUDLOW RD
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-4324
Mailing Address - Country:US
Mailing Address - Phone:413-535-4714
Mailing Address - Fax:413-535-4716
Practice Address - Street 1:100 WASON AVE STE 360
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1179
Practice Address - Country:US
Practice Address - Phone:413-736-1500
Practice Address - Fax:413-736-1600
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2310486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily