Healthcare Provider Details

I. General information

NPI: 1528468170
Provider Name (Legal Business Name): SHANNON HSU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 02/16/2025
Certification Date: 02/16/2025
Deactivation Date: 05/31/2017
Reactivation Date: 11/16/2017

III. Provider practice location address

9159 NOSTRAND AVE
LAS VEGAS NV
89148-4388
US

IV. Provider business mailing address

9159 NOSTRAND AVE
LAS VEGAS NV
89148-4388
US

V. Phone/Fax

Practice location:
  • Phone: 702-797-0283
  • Fax:
Mailing address:
  • Phone: 702-797-0283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8715-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: