Healthcare Provider Details

I. General information

NPI: 1871797563
Provider Name (Legal Business Name): CLARA CHEUNG R.D. C.D.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3712 PRINCE ST STE 5B
FLUSHING NY
11354-4650
US

IV. Provider business mailing address

3712 PRINCE ST STE 5B
FLUSHING NY
11354-4650
US

V. Phone/Fax

Practice location:
  • Phone: 718-886-7856
  • Fax: 718-228-8917
Mailing address:
  • Phone: 212-966-3829
  • Fax: 718-228-8917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number003676
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number003676
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: