Healthcare Provider Details

I. General information

NPI: 1750996914
Provider Name (Legal Business Name): SIFAN HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 NORTHERN BLVD
GREAT NECK NY
11021-5340
US

IV. Provider business mailing address

800 NORTHERN BLVD
GREAT NECK NY
11021-5340
US

V. Phone/Fax

Practice location:
  • Phone: 516-312-5522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: