Healthcare Provider Details

I. General information

NPI: 1184509689
Provider Name (Legal Business Name): PHOENIX WELLNESS ACUPUNCTURE AND MASSAGE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4267 SAULL ST
FLUSHING NY
11355-4917
US

IV. Provider business mailing address

4267 SAULL ST
FLUSHING NY
11355-4917
US

V. Phone/Fax

Practice location:
  • Phone: 929-329-6790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: XIAONA MO
Title or Position: PRESIDENT
Credential: LAC
Phone: 929-329-6790