Healthcare Provider Details

I. General information

NPI: 1376214098
Provider Name (Legal Business Name): JOOYUN SHIN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WASON AVE STE 360
SPRINGFIELD MA
01107-1179
US

IV. Provider business mailing address

262 NEW LUDLOW RD
CHICOPEE MA
01020-4324
US

V. Phone/Fax

Practice location:
  • Phone: 413-736-1500
  • Fax: 413-736-1600
Mailing address:
  • Phone: 413-535-4714
  • Fax: 413-535-4716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2310486
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: