Provider Demographics
NPI:1669997680
Name:JIANG, SHUXIA (CSA; CSFA)
Entity type:Individual
Prefix:
First Name:SHUXIA
Middle Name:
Last Name:JIANG
Suffix:
Gender:F
Credentials:CSA; CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 LILAS CT
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-3453
Mailing Address - Country:US
Mailing Address - Phone:507-383-3279
Mailing Address - Fax:815-417-9856
Practice Address - Street 1:624 LILAS CT
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-3453
Practice Address - Country:US
Practice Address - Phone:507-383-3279
Practice Address - Fax:815-417-9856
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZC0007X
IL238000557363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant