Provider Demographics
NPI:1588240451
Name:SHU-YIP, SEBASTIAN B
Entity Type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:B
Last Name:SHU-YIP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 E PRINCESS DR UNIT 1250
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-4113
Mailing Address - Country:US
Mailing Address - Phone:857-269-6429
Mailing Address - Fax:
Practice Address - Street 1:5323 HARRY HINES BOULEVARD DALLAS
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-0001
Practice Address - Country:US
Practice Address - Phone:214-648-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program