Provider Demographics
NPI:1699030593
Name:CHAN, SHIRLEY YU (RN, BSN, CDE)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:YU
Last Name:CHAN
Suffix:
Gender:F
Credentials:RN, BSN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 BROADWAY
Mailing Address - Street 2:# 14A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3940
Mailing Address - Country:US
Mailing Address - Phone:212-227-9619
Mailing Address - Fax:
Practice Address - Street 1:376 BROADWAY
Practice Address - Street 2:APT 14A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3940
Practice Address - Country:US
Practice Address - Phone:212-227-9619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-07
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY493224163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator