Healthcare Provider Details

I. General information

NPI: 1083377303
Provider Name (Legal Business Name): SIDNEY HSU PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 SLATER RD STE 120
EAGAN MN
55122-4048
US

IV. Provider business mailing address

850 SHENANDOAH DR APT C246
SHAKOPEE MN
55379-5093
US

V. Phone/Fax

Practice location:
  • Phone: 808-527-4953
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP7254
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: