Healthcare Provider Details

I. General information

NPI: 1720209430
Provider Name (Legal Business Name): CLARA CHEUNG NUTRITION CONSULTING, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13640 39TH AVE., SUITE 203
FLUSHING NY
11354-3105
US

IV. Provider business mailing address

13640 39TH AVE SUITE 203
FLUSHING NY
11354-5536
US

V. Phone/Fax

Practice location:
  • Phone: 718-886-7856
  • Fax: 718-886-7341
Mailing address:
  • Phone: 718-886-7856
  • Fax: 718-886-7341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number003676-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number003676-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number003676-1
License Number StateNY

VIII. Authorized Official

Name: MS. CLARA CHEUNG
Title or Position: NUTRITIONIST
Credential: R.D.
Phone: 718-886-7856