Healthcare Provider Details

I. General information

NPI: 1548984545
Provider Name (Legal Business Name): WAN-TING CHANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 BROADHOLLOW RD STE B12
MELVILLE NY
11747-3701
US

IV. Provider business mailing address

14125 NORTHERN BLVD APT C18
FLUSHING NY
11354-4206
US

V. Phone/Fax

Practice location:
  • Phone: 631-390-5951
  • Fax:
Mailing address:
  • Phone: 917-293-1325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number3080220
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number032654
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: