Provider Demographics
NPI:1255019394
Name:SHU, HSIAOJUNG (NP)
Entity type:Individual
Prefix:
First Name:HSIAOJUNG
Middle Name:
Last Name:SHU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 DOVER ST
Mailing Address - Street 2:STE 100
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8509
Mailing Address - Country:US
Mailing Address - Phone:317-706-7246
Mailing Address - Fax:
Practice Address - Street 1:97 DOVER ST
Practice Address - Street 2:STE 100
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8509
Practice Address - Country:US
Practice Address - Phone:317-706-7246
Practice Address - Fax:317-706-3417
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28233861A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health