Healthcare Provider Details

I. General information

NPI: 1710847025
Provider Name (Legal Business Name): XIAOMAN STEPHENS BSN, RN, CPN, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140-15B SANDFORD AVE FLR 2
FLUSHING NY
11355
US

IV. Provider business mailing address

140-15B SANDFORD AVE FLR 2
FLUSHING NY
11355
US

V. Phone/Fax

Practice location:
  • Phone: 718-358-8288
  • Fax:
Mailing address:
  • Phone: 718-358-8288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number202544912
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number781011
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number355730
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: