Provider Demographics
NPI:1851703367
Name:SHYU, CONNIE (PA-C)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:
Last Name:SHYU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20303 CRAWFORD AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1073
Mailing Address - Country:US
Mailing Address - Phone:708-983-6060
Mailing Address - Fax:
Practice Address - Street 1:20303 CRAWFORD AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1073
Practice Address - Country:US
Practice Address - Phone:708-983-6060
Practice Address - Fax:708-747-6911
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.005065363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical