Provider Demographics
NPI:1255938940
Name:KUAN, SHIRLEY (MSN, AGNP)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:KUAN
Suffix:
Gender:F
Credentials:MSN, AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605
Mailing Address - Country:US
Mailing Address - Phone:203-330-6000
Mailing Address - Fax:203-334-0398
Practice Address - Street 1:968 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-1116
Practice Address - Country:US
Practice Address - Phone:203-330-6000
Practice Address - Fax:203-334-0398
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2022-04-19
Deactivation Date:2022-03-18
Deactivation Code:
Reactivation Date:2022-04-18
Provider Licenses
StateLicense IDTaxonomies
CT153503163W00000X
CT9166207R00000X, 363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care