Provider Demographics
NPI:1477019875
Name:HSIEH, SHELLY SHUNJU (NP, PA)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:SHUNJU
Last Name:HSIEH
Suffix:
Gender:F
Credentials:NP, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 KEMPTON
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-2154
Mailing Address - Country:US
Mailing Address - Phone:609-240-5973
Mailing Address - Fax:
Practice Address - Street 1:5451 LA PALMA AVE STE 25
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1730
Practice Address - Country:US
Practice Address - Phone:714-670-1340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA831469163W00000X
CA95011129363L00000X
CA56403363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner