Provider Demographics
NPI:1255927208
Name:SHAU, CINDY YOON
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:YOON
Last Name:SHAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 GAGE AVE APT 418
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-1656
Mailing Address - Country:US
Mailing Address - Phone:678-371-3357
Mailing Address - Fax:
Practice Address - Street 1:7125 MARVIN D LOVE FWY STE 105
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3111
Practice Address - Country:US
Practice Address - Phone:469-646-6057
Practice Address - Fax:469-895-6057
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH83981183500000X
GARPH032524183500000X
TX68374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist