Provider Demographics
NPI:1861664948
Name:QIU, SHU (PA)
Entity Type:Individual
Prefix:MS
First Name:SHU
Middle Name:
Last Name:QIU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5645 MAIN ST
Mailing Address - Street 2:W238
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5045
Mailing Address - Country:US
Mailing Address - Phone:718-670-1572
Mailing Address - Fax:718-670-1864
Practice Address - Street 1:5645 MAIN ST
Practice Address - Street 2:W238
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-670-1572
Practice Address - Fax:718-670-1864
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY5493367363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical