MEDICARE: OLIVIA SHUN CHIANG PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	016540	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811910177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA SHUN CHIANG PSYD

Provider Business Mailing Address
First Line	:	6150 METROWEST BLVD STE 105
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-3290
Country	:	US
Telephone Number	:	321-842-6671
Fax Number	:	321-843-6447

Provider Business Practice Location Address
First Line	:	6150 METROWEST BLVD STE 105
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-3290
Country	:	US
Telephone Number	:	321-842-6671
Fax Number	:	321-843-6447

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	06/10/2024

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