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General NPI Number Information
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NPI Number | 1164396032
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Entity Type | Individual
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Provider Name | ANNIE SHU PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/02/2025
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 3530 N VANCOUVER AVE STE 400
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City | PORTLAND
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State | OR
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Zip | 97227-1798
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Country | US
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Telephone | 503-249-8851
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Fax | 503-282-3409
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Provider Business Mailing Address
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Address Line | 4822 SW WESTERN AVE APT 454
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City | BEAVERTON
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State | OR
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Zip | 97005-3471
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA227545
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License Number State | OR
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